Healthcare Provider Details

I. General information

NPI: 1447924865
Provider Name (Legal Business Name): DESIREE FORBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BELL ST
SACRAMENTO CA
95825-2303
US

IV. Provider business mailing address

PO BOX 269003
SACRAMENTO CA
95826-9003
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-5500
  • Fax:
Mailing address:
  • Phone: 916-228-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: