Provider Demographics
NPI:1417997123
Name:FOSTER, LADESSA KAYE (LCPC)
Entity Type:Individual
Prefix:
First Name:LADESSA
Middle Name:KAYE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5535
Mailing Address - Country:US
Mailing Address - Phone:208-343-3688
Mailing Address - Fax:208-342-3366
Practice Address - Street 1:720 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5535
Practice Address - Country:US
Practice Address - Phone:208-343-3688
Practice Address - Fax:208-342-3366
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-65101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health