Provider Demographics
NPI:1497840607
Name:FOUNDATIONS HEALTH AND WHOLENESS INC
Entity Type:Organization
Organization Name:FOUNDATIONS HEALTH AND WHOLENESS INC
Other - Org Name:AMERICAN FOUNDATION OF COUNSELING SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULAINE
Authorized Official - Middle Name:BELINDA
Authorized Official - Last Name:FELD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-437-8256
Mailing Address - Street 1:FOUNDATIONS HEALTH AND WHOLENESS INC
Mailing Address - Street 2:1061 W. MASON ST.
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-1858
Mailing Address - Country:US
Mailing Address - Phone:920-437-8256
Mailing Address - Fax:920-437-1188
Practice Address - Street 1:FOUNDATIONS HEALTH AND WHOLENESS INC
Practice Address - Street 2:1061 W MASON ST.
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-1858
Practice Address - Country:US
Practice Address - Phone:920-437-8256
Practice Address - Fax:920-437-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1035101YA0400X, 103TC2200X, 106H00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42180100Medicaid
WI=========011OtherBLUE CROSS BLUE SHIELD #
WI61620Medicare UPIN
WI84523Medicare ID - Type Unspecified