Provider Demographics
NPI:1093383184
Name:CRYSTAL FOSTER LICENSED MENTAL HEALTH COUNSELOR PLLC
Entity Type:Organization
Organization Name:CRYSTAL FOSTER LICENSED MENTAL HEALTH COUNSELOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:585-204-7790
Mailing Address - Street 1:805 RIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2410
Mailing Address - Country:US
Mailing Address - Phone:585-204-7790
Mailing Address - Fax:
Practice Address - Street 1:805 RIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2410
Practice Address - Country:US
Practice Address - Phone:585-204-7790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty