Basic Information
| Provider Information | |||||||||
| NPI: | 1275182743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOUNDATIONS COUNSELING AND ASSESSMENTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 452 N EOLA RD STE A | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605029110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309990401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 452 N EOLA RD STE A | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605029110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309990401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2019 | ||||||||
| LastUpdateDate: | 09/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | JIONGCO | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL/DIR OF DEV | ||||||||
| AuthorizedOfficialTelephone: | 3314727620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.