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General NPI Number Information
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NPI Number | 1336118330
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS BEHAVIORAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 4761 STATE ROUTE 29
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City | CELINA
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State | OH
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Zip | 45822-8216
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Country | US
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Telephone | 419-584-1000
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Fax | 419-584-1825
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Provider Business Mailing Address
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Address Line | 4761 STATE ROUTE 29
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City | CELINA
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State | OH
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Zip | 45822-8216
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Country | US
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Telephone | 419-584-1000
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Fax | 419-584-1825
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DIANE GABLE
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Credential | LISW
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Telephone | 419-584-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 0200893
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License Number State | OH
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