Provider Demographics
NPI:1164009353
Name:FOSTER, TYANN (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:MISS
First Name:TYANN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11755 MALAGA DR UNIT 1181
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8130
Mailing Address - Country:US
Mailing Address - Phone:909-342-0385
Mailing Address - Fax:
Practice Address - Street 1:11755 MALAGA DR UNIT 1181
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8130
Practice Address - Country:US
Practice Address - Phone:909-342-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool