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General NPI Number Information
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NPI Number | 1093516270
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Entity Type | Individual
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Provider Name | LARRY FOSTER JR. MSW
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Gender | Male
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Dates
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Enumeration Date | 03/22/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 1355 LYNNFIELD RD STE 189
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City | MEMPHIS
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State | TN
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Zip | 38119-5838
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Country | US
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Telephone | 901-300-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 7106 APPLECREEK
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City | MEMPHIS
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State | TN
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Zip | 38125-3403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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