Healthcare Provider Details

I. General information

NPI: 1720101355
Provider Name (Legal Business Name): JESSICA FOSTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA KIRKPATRICK LAC, LPC

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 PORTER WAGONER BLVD # 23
WEST PLAINS MO
65775-1826
US

IV. Provider business mailing address

1211 PORTER WAGONER BLVD # 23 P. O. BOX 1100
WEST PLAINS MO
65775-1826
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-6762
  • Fax: 417-257-5875
Mailing address:
  • Phone: 417-257-6762
  • Fax: 417-257-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1006033
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: