Healthcare Provider Details

I. General information

NPI: 1083638852
Provider Name (Legal Business Name): ANNIE G. FORSYTH LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CODIFER BLVD STE C
METAIRIE LA
70005-3782
US

IV. Provider business mailing address

5341 CARLISLE CT
NEW ORLEANS LA
70131-7242
US

V. Phone/Fax

Practice location:
  • Phone: 504-313-8601
  • Fax:
Mailing address:
  • Phone: 504-442-1594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2296
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2296
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number56700
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0341
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: