MEDICARE: RENE FOSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC.0018299	CO

General Provider Information

NPI Number	:	1073161568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE FOSTER

Provider Business Mailing Address
First Line	:	265 S HARLAN ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-2261
Country	:	US
Telephone Number	:	720-272-1289
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 E FOUNTAIN BLVD STE 140
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-1734
Country	:	US
Telephone Number	:	970-387-8299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	07/06/2022

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