| Foundations Behavioral Health Services, Inc. | |
|
4761 State Route 29 Celina OH 45822-8216 | |
| (419) 584-1000 | |
| (419) 584-1825 |
| Full Name | Foundations Behavioral Health Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4761 State Route 29, Celina, Ohio |
| Authorized Official Name and Position | Diane Gable (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4195841000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foundations Behavioral Health Services, Inc. 4761 State Route 29 Celina OH 45822-8216 Ph: (419) 584-1000 | Foundations Behavioral Health Services, Inc. 4761 State Route 29 Celina OH 45822-8216 Ph: (419) 584-1000 |
| NPI Number | 1336118330 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 12/14/2020 |
| Certification Date | 12/14/2020 |
| Medicare PECOS PAC ID | 0143204172 |
|---|---|
| Medicare Enrollment ID | O20040616000829 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336118330 | NPI | - | NPPES |
| 0200893 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 0200893 (Ohio) | Primary |
| Provider Name | Jacqueline A Carr |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003029968 PECOS PAC ID: 9537131602 Enrollment ID: I20040809001476 |
| Provider Name | Thomas O Osinowo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518044585 PECOS PAC ID: 4880723006 Enrollment ID: I20100526001089 |
| Provider Name | Roberta D Donovan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649444357 PECOS PAC ID: 4082840350 Enrollment ID: I20131114000519 |
| Provider Name | Wendelyn Belcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578010989 PECOS PAC ID: 4981992716 Enrollment ID: I20161011003271 |
| Provider Name | Temitayo Onamusi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265971394 PECOS PAC ID: 5799705455 Enrollment ID: I20170420000889 |
| Provider Name | Cristina L Khuth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043785322 PECOS PAC ID: 2860863065 Enrollment ID: I20230126001486 |
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