Provider Demographics
NPI:1730635244
Name:FOUST, JORDAN TAYLAR (MS)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:TAYLAR
Last Name:FOUST
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 LANCESHIRE LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-5410
Mailing Address - Country:US
Mailing Address - Phone:573-352-0041
Mailing Address - Fax:
Practice Address - Street 1:5521 LANCESHIRE LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-5410
Practice Address - Country:US
Practice Address - Phone:573-352-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst