MEDICARE: SHERRY LYNN FORSYTH CARTER MC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	LPC -1730	AZ
3	101YP2500X	Professional Counselor	4906	AZ

General Provider Information

NPI Number	:	1790771251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY LYNN FORSYTH CARTER MC, LPC

Provider Business Mailing Address
First Line	:	17999 TREGONING LN
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-8326
Country	:	US
Telephone Number	:	480-888-6223
Fax Number	:

Provider Business Practice Location Address
First Line	:	4435 E BROADWAY RD STE 3
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-2012
Country	:	US
Telephone Number	:	480-888-6223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	08/29/2024

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