MEDICARE: FOUNDATION COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1033051198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	702 N WYOMING AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-2173
Country	:	US
Telephone Number	:	505-205-2871
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 N WYOMING AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-2173
Country	:	US
Telephone Number	:	505-205-2871
Fax Number	:

Authorized Official
Title or Position	:	OWNWER
Name	:	CAMILLE CHAVEZ
Credential	:	LCSW
Telephone Number	:	505-205-2871

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “FOUNDATION COUNSELING SERVICES LLC ” Practice Location

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