Provider Demographics
NPI:1669695813
Name:GARY-FOUST, MARY (LMSW, MSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:GARY-FOUST
Suffix:
Gender:F
Credentials:LMSW, MSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:FOUST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, MSW
Mailing Address - Street 1:28119 GRAND DUKE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5218
Mailing Address - Country:US
Mailing Address - Phone:248-476-2229
Mailing Address - Fax:248-476-4434
Practice Address - Street 1:28119 GRAND DUKE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5218
Practice Address - Country:US
Practice Address - Phone:248-476-2229
Practice Address - Fax:248-476-4434
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010875791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical