Provider Demographics
NPI:1992428510
Name:FORWARD BOUND COUNSELING PLLC
Entity type:Organization
Organization Name:FORWARD BOUND COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:507-858-3019
Mailing Address - Street 1:522 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:MN
Mailing Address - Zip Code:56044-7709
Mailing Address - Country:US
Mailing Address - Phone:507-858-3019
Mailing Address - Fax:
Practice Address - Street 1:522 MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:MN
Practice Address - Zip Code:56044-7709
Practice Address - Country:US
Practice Address - Phone:507-858-3019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7305651Medicaid