Provider Demographics
NPI:1902654254
Name:FOUNDATIONS FOR LIVING WHOLE, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS FOR LIVING WHOLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:CHRISTOPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:307-763-2830
Mailing Address - Street 1:830 S THURMOND ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5059
Mailing Address - Country:US
Mailing Address - Phone:307-763-2830
Mailing Address - Fax:
Practice Address - Street 1:172 N MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3922
Practice Address - Country:US
Practice Address - Phone:307-763-2830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty