Healthcare Provider Details

I. General information

NPI: 1902336787
Provider Name (Legal Business Name): COLIN FOUST LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11016 PHOENIX AVE NE
ALBUQUERQUE NM
87112-1672
US

IV. Provider business mailing address

11016 PHOENIX AVE NE
ALBUQUERQUE NM
87112-1672
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-0528
  • Fax: 505-359-3231
Mailing address:
  • Phone: 505-908-0528
  • Fax: 505-359-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08537
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: