Provider Demographics
NPI:1366421828
Name:FORBESS-MCCORQUODALE, KERI (MS, CEAP, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:FORBESS-MCCORQUODALE
Suffix:
Gender:F
Credentials:MS, CEAP, 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 3126
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-3126
Mailing Address - Country:US
Mailing Address - Phone:337-477-2730
Mailing Address - Fax:337-436-3383
Practice Address - Street 1:1201 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5222
Practice Address - Country:US
Practice Address - Phone:337-436-3353
Practice Address - Fax:337-436-3383
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1725101YM0800X
LA98106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist