Provider Demographics
NPI:1760480875
Name:FOSTER, SHELLY A (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:SHELLY
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 LOGAN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5138
Mailing Address - Country:US
Mailing Address - Phone:970-817-3426
Mailing Address - Fax:307-638-8256
Practice Address - Street 1:1520 LOGAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5138
Practice Address - Country:US
Practice Address - Phone:970-817-3426
Practice Address - Fax:307-514-9445
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY275101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY130755000Medicaid
WY311228OtherBS