Provider Demographics
NPI:1124395835
Name:FOSTER, KEITH G (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:G
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W MAGNOLIA ST STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2927
Mailing Address - Country:US
Mailing Address - Phone:970-391-9956
Mailing Address - Fax:
Practice Address - Street 1:219 W MAGNOLIA ST STE 120
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2927
Practice Address - Country:US
Practice Address - Phone:970-391-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist