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General NPI Number Information
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NPI Number | 1336634906
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Entity Type | Organization
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Legal Business Name | GO FOSTER INC.
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 113 S MONROE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1529
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Country | US
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Telephone | 850-201-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 113 S MONROE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1529
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Country | US
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Telephone | 850-201-7313
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. THOMAS M CROOM
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Credential | PHD
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Telephone | 850-201-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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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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