=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407520513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY FOUNDATIONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2021
-----------------------------------------------------
Last Update Date | 08/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2399 S ORCHARD ST STE 200
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83705-3795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-860-7828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2399 S ORCHARD ST STE 200
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83705-3795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-860-7828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JOANNE WENGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-278-4272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------