Provider Demographics
NPI:1780965889
Name:FOSTER, BRYAN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 N 30TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3352
Mailing Address - Country:US
Mailing Address - Phone:253-778-6396
Mailing Address - Fax:
Practice Address - Street 1:2209 N 30TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3352
Practice Address - Country:US
Practice Address - Phone:253-778-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60292053106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist