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General NPI Number Information
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NPI Number | 1043538721
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS FAMILY RESOURCE CENTER
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 35251 KENAI SPUR HWY STE C
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City | SOLDOTNA
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State | AK
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Zip | 99669-7623
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Country | US
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Telephone | 907-252-9082
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1424
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City | SOLDOTNA
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State | AK
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Zip | 99669-1424
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Country | US
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Telephone | 907-252-9082
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | NOAH SHIELDS
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Credential | LPC
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Telephone | 907-252-9082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 798
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License Number State | AK
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