Provider Demographics
NPI:1285178418
Name:FORWARD TELEHEALTH & COUNSELING P.C.
Entity Type:Organization
Organization Name:FORWARD TELEHEALTH & COUNSELING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-345-5529
Mailing Address - Street 1:152 E LIBERTY RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:IN
Mailing Address - Zip Code:47452-1412
Mailing Address - Country:US
Mailing Address - Phone:812-865-8400
Mailing Address - Fax:812-865-8400
Practice Address - Street 1:152 E LIBERTY RD UNIT B
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:IN
Practice Address - Zip Code:47452-1412
Practice Address - Country:US
Practice Address - Phone:812-865-8400
Practice Address - Fax:812-865-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005227A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health