MEDICARE: MR. JEFFERY FRANKLIN FOSTER QMHP

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1366464570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFERY FRANKLIN FOSTER QMHP

Provider Business Mailing Address
First Line	:	1712 SE 111TH CT
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-6200
Country	:	US
Telephone Number	:	360-326-3816
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 NE 102ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-4167
Country	:	US
Telephone Number	:	503-253-6754
Fax Number	:	503-251-1344

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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