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General NPI Number Information
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NPI Number | 1558653071
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Entity Type | Individual
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Provider Name | BROOKE LYALL FORIS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 15101 6 MILE CYPRESS PARKWAY SUITE 115
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City | FORT MYERS
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State | FL
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Zip | 33966
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Country | US
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Telephone | 239-790-6614
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Fax | 239-344-7635
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Provider Business Mailing Address
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Address Line | 13650 FIDDLESTICKS BLVD. SUITE 202-104
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City | FORT MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-790-6614
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Fax | 239-344-7635
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 8274
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License Number State | FL
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