Provider Demographics
NPI:1154950350
Name:FOREMAN, STEPHEN JAY (LPC, NCC, NCSC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAY
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:LPC, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2247
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-2247
Mailing Address - Country:US
Mailing Address - Phone:907-654-9653
Mailing Address - Fax:
Practice Address - Street 1:1944 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6601
Practice Address - Country:US
Practice Address - Phone:907-654-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK129193101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor