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?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty