Provider Demographics
NPI:1275182743
Name:FOUNDATIONS COUNSELING AND ASSESSMENTS LLC
Entity Type:Organization
Organization Name:FOUNDATIONS COUNSELING AND ASSESSMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL/DIR OF DEV
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JIONGCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-472-7620
Mailing Address - Street 1:452 N EOLA RD STE A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9110
Mailing Address - Country:US
Mailing Address - Phone:630-999-0401
Mailing Address - Fax:
Practice Address - Street 1:452 N EOLA RD STE A
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9110
Practice Address - Country:US
Practice Address - Phone:630-999-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty