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General NPI Number Information
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NPI Number | 1053601724
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Entity Type | Individual
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Provider Name | FOREST TU PAVEL PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 06/19/2022
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Provider Practice Location Address
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Address Line | 1301 N WAREHOUSE RD
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027
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Country | US
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Telephone | 913-758-3757
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 NW 63RD TER
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City | KANSAS CITY
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State | MO
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Zip | 64151-4826
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Country | US
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Telephone | 540-421-2357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6192
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2022013155
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 03100
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005068
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License Number State | VA
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