Provider Demographics
NPI:1962777425
Name:FORREST, BLAKELY NICHELLE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:BLAKELY
Middle Name:NICHELLE
Last Name:FORREST
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 GIFFORD PL
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080-8669
Mailing Address - Country:US
Mailing Address - Phone:615-631-4279
Mailing Address - Fax:
Practice Address - Street 1:213 GIFFORD PL
Practice Address - Street 2:
Practice Address - City:JOELTON
Practice Address - State:TN
Practice Address - Zip Code:37080-8669
Practice Address - Country:US
Practice Address - Phone:615-631-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist