Provider Demographics
NPI:1558750570
Name:FOSKET, MATTHEW (MA, LIMHP, NCC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FOSKET
Suffix:
Gender:M
Credentials:MA, LIMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 E PHILIP AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6104
Mailing Address - Country:US
Mailing Address - Phone:308-532-4940
Mailing Address - Fax:308-532-4941
Practice Address - Street 1:1002 E PHILIP AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6104
Practice Address - Country:US
Practice Address - Phone:308-532-4940
Practice Address - Fax:308-532-4941
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4902101YM0800X
NE10466101YM0800X
NE1921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE601008767Medicaid