Basic Information
| Provider Information | |||||||||
| NPI: | 1699876144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORBES | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 COON RAPIDS BLVD NW | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554335831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637801520 | ||||||||
| FaxNumber: | 7637802114 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 COON RAPIDS BLVD NW | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554335831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637801520 | ||||||||
| FaxNumber: | 7637802114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2776 | MN | X | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | 354 | MN | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.