Provider Demographics
NPI:1942088950
Name:FOSKETT, TRACY JO
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:JO
Last Name:FOSKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRAYC
Other - Middle Name:JO
Other - Last Name:FOSKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHCA
Mailing Address - Street 1:18407 NE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3600
Mailing Address - Country:US
Mailing Address - Phone:360-601-7011
Mailing Address - Fax:
Practice Address - Street 1:3400 SE 196TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8862
Practice Address - Country:US
Practice Address - Phone:360-251-0341
Practice Address - Fax:360-693-2045
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health