Healthcare Provider Details

I. General information

NPI: 1639733496
Provider Name (Legal Business Name): FOUNDATIONS THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 12/27/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N HEMMER RD STE 209
PALMER AK
99645-9690
US

IV. Provider business mailing address

PO BOX 1723
PALMER AK
99645-1723
US

V. Phone/Fax

Practice location:
  • Phone: 907-331-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CAROLINA HERNANDEZ POWERS
Title or Position: OWNER
Credential: LCSW
Phone: 907-331-0123