Provider Demographics
NPI:1487778643
Name:FORRESTER, ANN MCCOLLAUM (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MCCOLLAUM
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:NELSON
Other - Last Name:MCCOLLAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:3064 E CANNON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3837
Mailing Address - Country:US
Mailing Address - Phone:602-527-4003
Mailing Address - Fax:602-482-1884
Practice Address - Street 1:4001 W PARADISE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-2939
Practice Address - Country:US
Practice Address - Phone:602-527-4003
Practice Address - Fax:602-482-1884
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0927101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional