Provider Demographics
NPI:1982836565
Name:FOUNDATION FOR COUNSELING LLC
Entity Type:Organization
Organization Name:FOUNDATION FOR COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-548-8733
Mailing Address - Street 1:15650 N BLACK CANYON HWY STE 130B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4040
Mailing Address - Country:US
Mailing Address - Phone:602-548-8733
Mailing Address - Fax:602-548-3112
Practice Address - Street 1:15650 N BLACK CANYON HWY STE 130B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4040
Practice Address - Country:US
Practice Address - Phone:602-548-8733
Practice Address - Fax:602-548-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 2479251S00000X
AZLPC 2478251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health