Provider Demographics
NPI:1821472887
Name:FOUNDATIONS OF WELLNESS, COUNSELING L.L.C
Entity Type:Organization
Organization Name:FOUNDATIONS OF WELLNESS, COUNSELING L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:612-564-5205
Mailing Address - Street 1:12305 JONQUIL ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-1780
Mailing Address - Country:US
Mailing Address - Phone:612-618-2064
Mailing Address - Fax:
Practice Address - Street 1:232 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1245
Practice Address - Country:US
Practice Address - Phone:612-564-5205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00954251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health