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General NPI Number Information
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NPI Number | 1659579928
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 629 RIVER ST STE C
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City | BELLEVILLE
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State | WI
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Zip | 53508-9189
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Country | US
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Telephone | 608-424-9100
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Fax | 608-424-9099
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Provider Business Mailing Address
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Address Line | 629 RIVER ST STE C
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City | BELLEVILLE
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State | WI
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Zip | 53508-9189
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Country | US
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Telephone | 608-445-0710
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Fax | 608-424-9099
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Authorized Official
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Title or Position | EXECUTIVE CO-DIRECTOR
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Name | MRS. ALISA COLLEEN KELLY-MARTINA
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Credential | LCSW
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Telephone | 608-424-9100
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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 | 2508
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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