Provider Demographics
NPI:1336169150
Name:FOSTER, DANIEL V (PSYD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:V
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6834
Mailing Address - Country:US
Mailing Address - Phone:406-390-2532
Mailing Address - Fax:406-549-7559
Practice Address - Street 1:125 BANK ST
Practice Address - Street 2:STE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4413
Practice Address - Country:US
Practice Address - Phone:406-549-7325
Practice Address - Fax:406-549-7559
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT274103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical