Healthcare Provider Details

I. General information

NPI: 1144152125
Provider Name (Legal Business Name): FOUNDATION FOR CHANGE INTEGRATED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 LINK AVE E
MORIARTY NM
87035
US

IV. Provider business mailing address

PO BOX 1392
MORIARTY NM
87035-1392
US

V. Phone/Fax

Practice location:
  • Phone: 505-306-4881
  • Fax:
Mailing address:
  • Phone: 505-306-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ASHLEY L SAUVE
Title or Position: THERAPIST
Credential: LCPC
Phone: 505-306-4881