Provider Demographics
NPI:1063603074
Name:FORREST, TERRY ALAN (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:ALAN
Last Name:FORREST
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3007
Mailing Address - Country:US
Mailing Address - Phone:503-535-1174
Mailing Address - Fax:503-535-1191
Practice Address - Street 1:419 CENTER ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2211
Practice Address - Country:US
Practice Address - Phone:971-506-1887
Practice Address - Fax:503-656-0649
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0274106H00000X
ORC0410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist