Healthcare Provider Details

I. General information

NPI: 1093526980
Provider Name (Legal Business Name): ALEC MARTIN FORSYTH MHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9806 28TH AVE SW # A303
SEATTLE WA
98126-4164
US

IV. Provider business mailing address

9806 28TH AVE SW # A303
SEATTLE WA
98126-4164
US

V. Phone/Fax

Practice location:
  • Phone: 253-765-8270
  • Fax:
Mailing address:
  • Phone: 253-765-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61622237
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: