MEDICARE: FUTURE FOUNDATIONS 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)
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1285979658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUTURE FOUNDATIONS SERVICES LLC

Provider Business Mailing Address
First Line	:	3230 S BUFFALO DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2506
Country	:	US
Telephone Number	:	888-337-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 S BUFFALO DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2506
Country	:	US
Telephone Number	:	888-337-4551
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	MICHAEL BROWN
Credential	:
Telephone Number	:	702-460-4533

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	08/17/2021

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