Individual
MR. ROBERT JAMES FORSYTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
G 10- P-01
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10-09-71
OR
171M00000X
Case Manager/Care Coordinator
21-QMHA-I-003223
OR
175T00000X
Peer Specialist
21-CRM-714
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4861702
DRIVERS LICENSE
OR
05
—
500701049
—
OR
Enumeration date
02/04/2016
Last updated
06/30/2022
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