Provider Demographics
NPI:1457737793
Name:FOUNDATIONS MENTAL HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS MENTAL HEALTH CENTER, LLC
Other - Org Name:THERAPEUTIC REFLECTIONS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HECHT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, CCTP
Authorized Official - Phone:712-252-7170
Mailing Address - Street 1:3450 S LAKEPORT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4543
Mailing Address - Country:US
Mailing Address - Phone:712-252-7170
Mailing Address - Fax:712-252-7173
Practice Address - Street 1:3450 S LAKEPORT ST
Practice Address - Street 2:SUITE B
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4543
Practice Address - Country:US
Practice Address - Phone:712-252-7170
Practice Address - Fax:712-252-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14090101YA0400X
IA072360101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA600968049Medicaid