Provider Demographics
NPI:1245943380
Name:MARTIN, FORREST D (NONE)
Entity type:Individual
Prefix:
First Name:FORREST
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:M
Credentials:NONE
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Mailing Address - Street 1:201 N BRAND BLVD OFC 233
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3588
Mailing Address - Country:US
Mailing Address - Phone:818-722-1770
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:201 N BRAND BLVD OFC 233
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3588
Practice Address - Country:US
Practice Address - Phone:818-722-1770
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician