Provider Demographics
NPI:1740641711
Name:FOSTER, JAMES JR (MA PLMFT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:MA PLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1601
Mailing Address - Country:US
Mailing Address - Phone:224-407-4400
Mailing Address - Fax:224-407-2255
Practice Address - Street 1:40 SKOKIE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1614
Practice Address - Country:US
Practice Address - Phone:224-407-4400
Practice Address - Fax:224-407-2255
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001217101Y00000X
MO2014010646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherNOT APPLICABLE