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General NPI Number Information
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NPI Number | 1326429598
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 06/14/2015
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Last Update Date | 06/14/2024
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Provider Practice Location Address
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Address Line | 16382 E HIGHWAY 20
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City | CLAREMORE
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State | OK
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Zip | 74019-3946
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Country | US
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Telephone | 918-508-9696
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3062
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City | CLAREMORE
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State | OK
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Zip | 74018-3062
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Country | US
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Telephone | 918-508-9696
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GRACE BALLARD
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Credential | MSW,CSW
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Telephone | 918-508-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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