Provider Demographics
NPI:1932278116
Name:FOSTER, KENT H (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:H
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:KENT
Other - Middle Name:H
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:STE D3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1131
Mailing Address - Country:US
Mailing Address - Phone:512-797-7025
Mailing Address - Fax:512-292-1144
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:STE D3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1131
Practice Address - Country:US
Practice Address - Phone:512-797-7025
Practice Address - Fax:512-292-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23772103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152844001Medicaid
TX152844001Medicaid