| Foundations Family Support Llc | |
|
922 S Cowley St Ste 9 Spokane WA 99202-1263 | |
| (855) 995-6777 | |
| (509) 676-6655 |
| Full Name | Foundations Family Support Llc |
|---|---|
| Speciality | Counselor |
| Location | 922 S Cowley St Ste 9, Spokane, Washington |
| Authorized Official Name and Position | Jarrod Meade (BILLING/CREDENTIALING) |
| Authorized Official Contact | 5098226777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foundations Family Support Llc 922 S Cowley St Ste 9 Spokane WA 99202-1263 Ph: (855) 995-6777 | Foundations Family Support Llc 922 S Cowley St Ste 9 Spokane WA 99202-1263 Ph: (855) 995-6777 |
| NPI Number | 1083103238 |
|---|---|
| Provider Enumeration Date | 05/03/2018 |
| Last Update Date | 12/30/2024 |
| Certification Date | 12/30/2024 |
| Medicare PECOS PAC ID | 0547669731 |
|---|---|
| Medicare Enrollment ID | O20210519002809 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083103238 | NPI | - | NPPES |
| 2104214 | Medicaid | WA |
| Provider Name | Benjamin Charles Marlow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861651648 PECOS PAC ID: 2466764154 Enrollment ID: I20150709000981 |
| Provider Name | Gretchen H Van Bodegom |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649938168 PECOS PAC ID: 0749712008 Enrollment ID: I20241011002903 |
| Provider Name | Alysa Rey Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508333071 PECOS PAC ID: 9830621861 Enrollment ID: I20241016000917 |
| Provider Name | Lauren Tongish Rath |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861972622 PECOS PAC ID: 2163955410 Enrollment ID: I20241025001293 |
| Provider Name | Tami Beelaert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265804942 PECOS PAC ID: 2062945900 Enrollment ID: I20241030001756 |
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