Provider Demographics
NPI:1083103238
Name:FOUNDATIONS FAMILY SUPPORT LLC
Entity Type:Organization
Organization Name:FOUNDATIONS FAMILY SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBING
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, CDP, CMHS
Authorized Official - Phone:509-822-6777
Mailing Address - Street 1:922 S COWLEY ST STE 9
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1263
Mailing Address - Country:US
Mailing Address - Phone:509-822-6777
Mailing Address - Fax:509-822-6777
Practice Address - Street 1:922 S COWLEY ST STE 9
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1263
Practice Address - Country:US
Practice Address - Phone:509-822-6777
Practice Address - Fax:509-822-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60786955101YM0800X
1041C0700X, 106H00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2104214Medicaid