Provider Demographics
NPI: | 1225701683 |
---|---|
Name: | FOUNDATION THOUGHTS |
Entity Type: | Organization |
Organization Name: | FOUNDATION THOUGHTS |
Other - Org Name: | FOUNDATION THOUGHTS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PROVIDER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHIBA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NIXON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 313-550-9605 |
Mailing Address - Street 1: | 19785 W 12 MILE RD # 644 |
Mailing Address - Street 2: | |
Mailing Address - City: | SOUTHFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48076-2584 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-252-0531 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 29781 SPRING HILL DR |
Practice Address - Street 2: | |
Practice Address - City: | SOUTHFIELD |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48076-1859 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-252-0531 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-07-30 |
Last Update Date: | 2021-11-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |