Healthcare Provider Details

I. General information

NPI: 1821897489
Provider Name (Legal Business Name): FOREST COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 CHETCO AVE STE D
BROOKINGS OR
97415-2562
US

IV. Provider business mailing address

94249 8TH ST # 1
GOLD BEACH OR
97444-7750
US

V. Phone/Fax

Practice location:
  • Phone: 541-373-9779
  • Fax: 458-203-5051
Mailing address:
  • Phone: 541-254-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICO Z FOREST
Title or Position: OWNER
Credential: LPC
Phone: 541-373-9779