Provider Demographics
NPI:1104051820
Name:FOSTER, ROBERT ALAN
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N MILL ST UNIT 63
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9658
Mailing Address - Country:US
Mailing Address - Phone:541-515-0195
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH SUITE 290
Practice Address - Street 2:SHELTER CARE
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health