Provider Demographics
NPI:1316249329
Name:FOSTER, EVA ELIZABETH (MS, LPCC, LADAC)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:ELIZABETH
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS, LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1189
Mailing Address - Country:US
Mailing Address - Phone:575-746-9848
Mailing Address - Fax:575-746-9840
Practice Address - Street 1:3600 HULEN ST
Practice Address - Street 2:SUITE B-4
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6863
Practice Address - Country:US
Practice Address - Phone:817-377-2800
Practice Address - Fax:817-377-2802
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9079101YA0400X
NMCAD0189441101YA0400X
TX67684101YM0800X
NMCCMH0194861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health