Healthcare Provider Details

I. General information

NPI: 1083103238
Provider Name (Legal Business Name): FOUNDATIONS FAMILY SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 S COWLEY ST STE 9
SPOKANE WA
99202-1263
US

IV. Provider business mailing address

922 S COWLEY ST STE 9
SPOKANE WA
99202-1263
US

V. Phone/Fax

Practice location:
  • Phone: 855-995-6777
  • Fax: 509-676-6655
Mailing address:
  • Phone: 855-995-6777
  • Fax: 509-676-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60786955
License Number StateWA

VIII. Authorized Official

Name: JARROD MEADE
Title or Position: BILLING/CREDENTIALING
Credential:
Phone: 509-822-6777