Healthcare Provider Details

I. General information

NPI: 1932278116
Provider Name (Legal Business Name): KENT H FOSTER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KENT H FOSTER PHD

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST STE D3
AUSTIN TX
78705-1131
US

IV. Provider business mailing address

711 W 38TH ST STE D3
AUSTIN TX
78705-1131
US

V. Phone/Fax

Practice location:
  • Phone: 512-797-7025
  • Fax: 512-292-1144
Mailing address:
  • Phone: 512-797-7025
  • Fax: 512-292-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number23772
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number23772
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: