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Contact Information

CHRISTY A FORKENBROCK, M.A. RAS
122 MEADOW LANE
MAMMOTH LAKES, CA93546
 Phone: 760-647-6236
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction (Substance Use Disorder)

101YA0400X
Indicates primary specialty

NPI Profile & details for CHRISTY A FORKENBROCK · (Female)

NPI Number 1619021060
Status Active
Credentials M.A. RAS
Entity Individual
Enumeration date 01/23/2007
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # F0401230924
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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