Healthcare Provider Details

I. General information

NPI: 1760480875
Provider Name (Legal Business Name): SHELLY A FOSTER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LOGAN AVE STE 3
CHEYENNE WY
82001-5138
US

IV. Provider business mailing address

1520 LOGAN AVE STE 3
CHEYENNE WY
82001-5138
US

V. Phone/Fax

Practice location:
  • Phone: 970-817-3426
  • Fax: 307-514-9445
Mailing address:
  • Phone: 970-817-3426
  • Fax: 307-638-8256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number275
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: