Provider Demographics
NPI:1417738550
Name:FORWARD TOGETHER/ADELANTE JUNTOS COUNSELING, LLC
Entity Type:Organization
Organization Name:FORWARD TOGETHER/ADELANTE JUNTOS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLOM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC
Authorized Official - Phone:804-370-9663
Mailing Address - Street 1:2204 18TH AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9722
Mailing Address - Country:US
Mailing Address - Phone:804-370-9663
Mailing Address - Fax:
Practice Address - Street 1:2204 18TH AVE STE 140
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9722
Practice Address - Country:US
Practice Address - Phone:804-370-9663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty