Provider Demographics
NPI:1225537434
Name:FOSTER, MARISSA ROSE (MA, LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ROSE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 N CRIMSON CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1607
Mailing Address - Country:US
Mailing Address - Phone:719-331-4748
Mailing Address - Fax:
Practice Address - Street 1:5265 N ACADEMY BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4083
Practice Address - Country:US
Practice Address - Phone:719-466-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional