Provider Demographics
NPI:1447693197
Name:FORESTAL, TANIKA D (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TANIKA
Middle Name:D
Last Name:FORESTAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CARTER CT
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-7026
Mailing Address - Country:US
Mailing Address - Phone:765-631-3366
Mailing Address - Fax:
Practice Address - Street 1:1149 E CENTER RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-5369
Practice Address - Country:US
Practice Address - Phone:765-631-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001791A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist