Healthcare Provider Details

I. General information

NPI: 1285979658
Provider Name (Legal Business Name): FUTURE FOUNDATIONS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 S BUFFALO DR STE 101
LAS VEGAS NV
89117-2506
US

IV. Provider business mailing address

3230 S BUFFALO DR STE 101
LAS VEGAS NV
89117-2506
US

V. Phone/Fax

Practice location:
  • Phone: 888-337-4551
  • Fax:
Mailing address:
  • Phone: 888-337-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
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: MICHAEL BROWN
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 702-460-4533