Provider Demographics
NPI:1003061029
Name:FOUNDATIONS TREATMENT CENTER
Entity Type:Organization
Organization Name:FOUNDATIONS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:WELANETZ-BURSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:888-800-5761
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1564
Mailing Address - Country:US
Mailing Address - Phone:888-800-5761
Mailing Address - Fax:818-530-7808
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1564
Practice Address - Country:US
Practice Address - Phone:888-800-5761
Practice Address - Fax:818-530-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty