Provider Demographics
NPI:1124475264
Name:DYLAN FOSTER COUNSELING
Entity type:Organization
Organization Name:DYLAN FOSTER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:231-920-8749
Mailing Address - Street 1:201 N MITCHELL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1859
Mailing Address - Country:US
Mailing Address - Phone:231-920-8749
Mailing Address - Fax:
Practice Address - Street 1:201 N MITCHELL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1859
Practice Address - Country:US
Practice Address - Phone:231-920-8749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015391251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health