Provider Demographics
NPI:1093486649
Name:FOUNDATIONS FAMILY AND INDIVIDUAL COUNSELING, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS FAMILY AND INDIVIDUAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHWITTERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-540-8410
Mailing Address - Street 1:1805 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-4805
Mailing Address - Country:US
Mailing Address - Phone:815-540-8410
Mailing Address - Fax:
Practice Address - Street 1:124 N WATER ST STE 303B
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3975
Practice Address - Country:US
Practice Address - Phone:815-540-8410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health