Healthcare Provider Details

I. General information

NPI: 1154874659
Provider Name (Legal Business Name): FORREST HOWARD BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 10/07/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE WORLD TRADE CENTER, 121 SOUTHWEST SALMON STREET 11TH FLOOR
PORTLAND OR
97204-0000
US

IV. Provider business mailing address

4221 WILSHIRE BLVD STE 300A
LOS ANGELES CA
90010-3537
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-22299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: