MEDICARE: MICHELE AARON FOUTS MA

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	103TC0700X	Clinical Psychologist	0470084103	VT

General Provider Information

NPI Number	:	1164780946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE AARON FOUTS MA

Provider Business Mailing Address
First Line	:	87 RIVERS BEND RD
Second Line	:
City	:	NEW HAVEN
State	:	VT
Zip	:	05472-1101
Country	:	US
Telephone Number	:	802-388-3887
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 RIVERS BEND RD
Second Line	:
City	:	NEW HAVEN
State	:	VT
Zip	:	05472-1101
Country	:	US
Telephone Number	:	802-388-3887
Fax Number	:

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

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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