Provider Demographics
NPI:1902149305
Name:FORREST, KABRINA S (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:KABRINA
Middle Name:S
Last Name:FORREST
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2632
Mailing Address - Country:US
Mailing Address - Phone:314-397-9948
Mailing Address - Fax:
Practice Address - Street 1:306 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2632
Practice Address - Country:US
Practice Address - Phone:314-397-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011035785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health