Provider Demographics
NPI:1679141774
Name:FUTURE FORWARD BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:FUTURE FORWARD BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, APRN
Authorized Official - Phone:270-713-0799
Mailing Address - Street 1:1020 HALIFAX DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6991
Mailing Address - Country:US
Mailing Address - Phone:270-713-0799
Mailing Address - Fax:270-713-0788
Practice Address - Street 1:1020 HALIFAX DR STE 102
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6991
Practice Address - Country:US
Practice Address - Phone:270-713-0799
Practice Address - Fax:270-713-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty