Provider Demographics
NPI:1407147770
Name:FOSTER, RYAN D (PHD, LPC -S)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:D
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PHD, LPC -S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 LISBON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5673
Mailing Address - Country:US
Mailing Address - Phone:817-631-9184
Mailing Address - Fax:
Practice Address - Street 1:3815 LISBON ST STE 202
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5673
Practice Address - Country:US
Practice Address - Phone:817-631-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63186101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional