Provider Demographics
NPI:1063914869
Name:FORISTER, AMANDA (MS)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:FORISTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 OAK FERN CIR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4875
Mailing Address - Country:US
Mailing Address - Phone:307-363-2250
Mailing Address - Fax:
Practice Address - Street 1:200 E GRANADA BLVD STE D
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6694
Practice Address - Country:US
Practice Address - Phone:307-257-2331
Practice Address - Fax:307-670-8042
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1056101YM0800X
WYLPC1828101YM0800X
FLMH24302103K00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst