Provider Demographics
NPI:1790194843
Name:FORWARD MOMENTUM COUNSELING
Entity Type:Organization
Organization Name:FORWARD MOMENTUM COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TREVIRANUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-216-9032
Mailing Address - Street 1:1414 GAY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2928
Mailing Address - Country:US
Mailing Address - Phone:407-216-9032
Mailing Address - Fax:407-386-6766
Practice Address - Street 1:1414 GAY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2928
Practice Address - Country:US
Practice Address - Phone:407-216-9032
Practice Address - Fax:407-386-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-03
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty