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General NPI Number Information
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NPI Number | 1093486649
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS FAMILY AND INDIVIDUAL COUNSELING, LLC
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 124 N WATER ST STE 303B
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City | ROCKFORD
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State | IL
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Zip | 61107-3975
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Country | US
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Telephone | 815-540-8410
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 CLINTON ST
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City | ROCKFORD
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State | IL
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Zip | 61103-4805
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Country | US
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Telephone | 815-540-8410
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KARYN B SCHWITTERS
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Credential | LCSW
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Telephone | 815-540-8410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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