Provider Demographics
NPI:1205879723
Name:FOSTER-WILSON, MARTHA LOUISE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LOUISE
Last Name:FOSTER-WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 FRENCHMANS DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7763
Mailing Address - Country:US
Mailing Address - Phone:972-298-4879
Mailing Address - Fax:972-283-9237
Practice Address - Street 1:1220 FRENCHMANS DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-7763
Practice Address - Country:US
Practice Address - Phone:469-571-1850
Practice Address - Fax:972-780-0219
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153251Medicaid
TX3972LCOtherBCBS