Provider Demographics
NPI:1043883473
Name:DEYOUNG-FOSTER, THERESA KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:KAY
Last Name:DEYOUNG-FOSTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 FAIRFIELD AVE.
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-2666
Mailing Address - Country:US
Mailing Address - Phone:269-370-9413
Mailing Address - Fax:
Practice Address - Street 1:57239 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9419
Practice Address - Country:US
Practice Address - Phone:269-273-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010857531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical