Provider Demographics
NPI:1760166458
Name:FAR AND BEYOND MENTORING SERVICES
Entity Type:Organization
Organization Name:FAR AND BEYOND MENTORING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMANETU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-200-0038
Mailing Address - Street 1:203 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4445
Mailing Address - Country:US
Mailing Address - Phone:434-200-0038
Mailing Address - Fax:
Practice Address - Street 1:117A TRADEWYND DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3112
Practice Address - Country:US
Practice Address - Phone:434-200-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty