Provider Demographics
NPI:1639926835
Name:FOSTER, PATRICK AARON (LPC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:AARON
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W SW LOOP 323 STE 101
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9455
Mailing Address - Country:US
Mailing Address - Phone:903-402-3822
Mailing Address - Fax:
Practice Address - Street 1:515 W SW LOOP 323 STE 101
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9455
Practice Address - Country:US
Practice Address - Phone:903-402-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88353101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional