1922804657 NPI number — GOING FORWARD BEHAVIOR COACHING

Table of content: ELIZABETH MORGAN DEMARTINI MS, ATC, LAT (NPI 1568982320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922804657 NPI number — GOING FORWARD BEHAVIOR COACHING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOING FORWARD BEHAVIOR COACHING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922804657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLMEN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54636-0144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-317-8574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N8135 CAMBRIAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLMEN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54636-9279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-317-8574
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
STREY
Authorized Official First Name:
LINDSAY
Authorized Official Middle Name:
SUE KELLY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
608-317-8574

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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