Provider Demographics
NPI:1124690722
Name:FOSTER, JULIE ANNETTE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNETTE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3200 SANGUINET ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5355
Mailing Address - Country:US
Mailing Address - Phone:817-255-2652
Mailing Address - Fax:817-255-2657
Practice Address - Street 1:3200 SANGUINET ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5355
Practice Address - Country:US
Practice Address - Phone:817-255-2652
Practice Address - Fax:817-255-2657
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical