Provider Demographics
NPI:1386115053
Name:FORSYTHE, WILLIAM BURTON (LPC, NBCC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BURTON
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:LPC, NBCC
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 253
Mailing Address - Street 2:
Mailing Address - City:SLIGO
Mailing Address - State:PA
Mailing Address - Zip Code:16255-0253
Mailing Address - Country:US
Mailing Address - Phone:256-509-4056
Mailing Address - Fax:
Practice Address - Street 1:349 N MCKEAN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4928
Practice Address - Country:US
Practice Address - Phone:256-509-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional