Provider Demographics
NPI:1326429598
Name:FOUNDATIONS BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,CSW
Authorized Official - Phone:918-508-9696
Mailing Address - Street 1:1218 N FLORENCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3755
Mailing Address - Country:US
Mailing Address - Phone:918-508-9696
Mailing Address - Fax:
Practice Address - Street 1:1218 N FLORENCE AVE STE B
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3755
Practice Address - Country:US
Practice Address - Phone:918-508-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-14
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty