Provider Demographics
NPI:1902239643
Name:FORRESTER, JULIE ELLEN (LIMHP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELLEN
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43589 CALLAWAY RD
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-7114
Mailing Address - Country:US
Mailing Address - Phone:308-880-5872
Mailing Address - Fax:308-880-5872
Practice Address - Street 1:805 S F ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2433
Practice Address - Country:US
Practice Address - Phone:308-880-5872
Practice Address - Fax:308-880-5872
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10027101YM0800X
NE2936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health