Provider Demographics
NPI:1063853463
Name:FOSTER, ANTHONY K (LLPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:K
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-0041
Mailing Address - Country:US
Mailing Address - Phone:517-575-7101
Mailing Address - Fax:
Practice Address - Street 1:1825 PEPPERTREE LN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3724
Practice Address - Country:US
Practice Address - Phone:517-575-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional