1366713109 NPI number — FOSTER COUNSELING & FAMILY THERAPY

Table of content: MRS. LORI ELIZABETH BRISTOW A.T.C. (NPI 1730173188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366713109 NPI number — FOSTER COUNSELING & FAMILY THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOSTER COUNSELING & FAMILY THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366713109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8331 REDBIRD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77044-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-754-0433
Provider Business Mailing Address Fax Number:
281-458-7504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8331 REDBIRD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77044-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-754-0433
Provider Business Practice Location Address Fax Number:
281-458-7504
Provider Enumeration Date:
01/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
SOLEL PROPRIETER
Authorized Official Telephone Number:
832-754-0433

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  15522 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 181170501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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