Provider Demographics
NPI:1750254827
Name:FOSTER, KEVIN STUART
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:STUART
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 BROADWAY STE 170
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3778
Mailing Address - Country:US
Mailing Address - Phone:253-640-4049
Mailing Address - Fax:
Practice Address - Street 1:4924 LA HAL DA AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1626
Practice Address - Country:US
Practice Address - Phone:352-723-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61661961101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor