Provider Demographics
NPI:1225326713
Name:FOSTER, MARY JANE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 HITCHING POST RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2135
Mailing Address - Country:US
Mailing Address - Phone:517-337-3059
Mailing Address - Fax:
Practice Address - Street 1:1305 HITCHING POST RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2135
Practice Address - Country:US
Practice Address - Phone:517-337-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008266101YP2500X
MIPF0001380101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool