Individual
FORREST RACKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
575B BLUES LAKE PKWY, ROLLA, MO 65401-8587
(573) 364-2007
(573) 202-2402
Mailing address
575B BLUES LAKE PKWY, ROLLA, MO 65401-8587
(573) 364-2007
(573) 202-2402
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
0810004701
VA
103TC0700X
Clinical Psychologist
Primary
2017010362
MO
Other
Enumeration date
01/18/2013
Last updated
10/09/2025
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