Healthcare Provider Details

I. General information

NPI: 1659579928
Provider Name (Legal Business Name): FOUNDATIONS COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 RIVER ST STE C
BELLEVILLE WI
53508-9189
US

IV. Provider business mailing address

629 RIVER ST STE C
BELLEVILLE WI
53508-9189
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-9100
  • Fax: 608-424-9099
Mailing address:
  • Phone: 608-445-0710
  • Fax: 608-424-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2508
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALISA COLLEEN KELLY-MARTINA
Title or Position: EXECUTIVE CO-DIRECTOR
Credential: LCSW
Phone: 608-424-9100