Provider Demographics
NPI:1982145306
Name:FOUNDATIONS IN BEHAVIOR, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS IN BEHAVIOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LORNE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BALMER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:765-776-6668
Mailing Address - Street 1:255 PRIMERA BLVD
Mailing Address - Street 2:SUITE 160B
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2158
Mailing Address - Country:US
Mailing Address - Phone:765-776-6668
Mailing Address - Fax:
Practice Address - Street 1:255 PRIMERA BLVD
Practice Address - Street 2:SUITE 160B
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2158
Practice Address - Country:US
Practice Address - Phone:765-776-6668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-16-7295251S00000X
1-09-5012251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018833200Medicaid
FL018489600Medicaid