| Doctor Name: | MICHAEL DEAN FORSYTHE |
| NPI Number: | 1134588536 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADC |
| License Number: | 303878 |
| Business Practice Address: | 855 Mankato Ave Winona, MN - 559874868 |
| Business Phone Number: | 5074543650 |
| Business Fax Number: | |
| Mailing Address: | 765 W King St, WINONA |
| State: | MN |
| Postal Code: | 559872748 |
| Phone Number: | 5079610350 |
| Fax Number: | |
| NPI Enumeration Date: | 02/15/2016 |
| NPI Last Update Date: | 02/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 303878 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |