Provider Demographics
NPI:1629967369
Name:FOSTER, MARY ALYSIA (MED, LPCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALYSIA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W IRVINE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1438
Mailing Address - Country:US
Mailing Address - Phone:502-783-7573
Mailing Address - Fax:844-822-8194
Practice Address - Street 1:244 W IRVINE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1438
Practice Address - Country:US
Practice Address - Phone:502-783-7573
Practice Address - Fax:844-822-8194
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY299841101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional