Provider Demographics
NPI:1871763391
Name:HENNING, FOREST DANIEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:FOREST
Middle Name:DANIEL
Last Name:HENNING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4821
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-4821
Mailing Address - Country:US
Mailing Address - Phone:406-531-0702
Mailing Address - Fax:
Practice Address - Street 1:910 BROOKS ST STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5784
Practice Address - Country:US
Practice Address - Phone:406-721-4918
Practice Address - Fax:406-329-3006
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical