Provider Demographics
NPI:1548005598
Name:FOSTER, ANTIONETTE (LPC)
Entity type:Individual
Prefix:MS
First Name:ANTIONETTE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNIVERSITY DR STE 112
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2170
Mailing Address - Country:US
Mailing Address - Phone:817-952-6956
Mailing Address - Fax:817-818-1821
Practice Address - Street 1:601 UNIVERSITY DR STE 112
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2170
Practice Address - Country:US
Practice Address - Phone:817-791-5609
Practice Address - Fax:817-818-1821
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-29
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95334101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty