Healthcare Provider Details

I. General information

NPI: 1023785672
Provider Name (Legal Business Name): FOUNDATIONAL WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 BASELINE RD STE 112
BOULDER CO
80303-2318
US

IV. Provider business mailing address

29483 SPRUCE CANYON DR
GOLDEN CO
80403-8430
US

V. Phone/Fax

Practice location:
  • Phone: 720-955-3260
  • Fax:
Mailing address:
  • Phone: 303-514-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER DRUCKMAN
Title or Position: CLINICIAN OWNER OPERATOR
Credential: LPC
Phone: 720-955-3260