Provider Demographics
NPI:1225721731
Name:FORWARD MOVEMENT THERAPY AND COACHING
Entity Type:Organization
Organization Name:FORWARD MOVEMENT THERAPY AND COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW, MSW
Authorized Official - Phone:612-644-2980
Mailing Address - Street 1:2924 WICKLOW ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-1407
Mailing Address - Country:US
Mailing Address - Phone:612-644-2980
Mailing Address - Fax:
Practice Address - Street 1:2924 WICKLOW ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1407
Practice Address - Country:US
Practice Address - Phone:612-644-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health