Provider Demographics
NPI:1447321948
Name:FOSTER, STEPHEN CHARLES (MS)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:CHARLES
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:522 E LAKE MEAD PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5530
Mailing Address - Country:US
Mailing Address - Phone:702-486-6720
Mailing Address - Fax:702-486-6741
Practice Address - Street 1:522 E LAKE MEAD PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5530
Practice Address - Country:US
Practice Address - Phone:702-486-6720
Practice Address - Fax:702-486-6741
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3030-S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health