Provider Demographics
NPI:1376361758
Name:FOSTER, BRYAN HOWARD (SUDPT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:HOWARD
Last Name:FOSTER
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0959
Mailing Address - Country:US
Mailing Address - Phone:509-453-4301
Mailing Address - Fax:
Practice Address - Street 1:307 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3446
Practice Address - Country:US
Practice Address - Phone:509-453-4274
Practice Address - Fax:509-453-4387
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO-61488986101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)