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General NPI Number Information
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NPI Number | 1083051726
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 6641 N HIGH ST SUITE 205
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City | WORTHINGTON
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State | OH
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Zip | 43085-4038
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Country | US
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Telephone | 614-504-4466
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Fax | 614-504-4464
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Provider Business Mailing Address
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Address Line | 6641 N HIGH ST SUITE 205
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City | WORTHINGTON
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State | OH
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Zip | 43085-4038
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Country | US
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Telephone | 614-504-4466
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Fax | 614-504-4464
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Authorized Official
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Title or Position | OWNER
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Name | MR. JESSE L THORNTON
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Credential | PSY.D.
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Telephone | 614-504-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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