Healthcare Provider Details

I. General information

NPI: 1740125483
Provider Name (Legal Business Name): BRANDON MICHAEL FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 VICTORY DR STE 3
LIBERTY MO
64068-1967
US

IV. Provider business mailing address

9 VICTORY DR STE 3
LIBERTY MO
64068-1967
US

V. Phone/Fax

Practice location:
  • Phone: 816-268-8501
  • Fax:
Mailing address:
  • Phone: 816-268-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2024029146
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: