Provider Demographics
NPI:1720101355
Name:FOSTER, JESSICA (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, LPC
Mailing Address - Street 1:1211 PORTER WAGONER BLVD # 23
Mailing Address - Street 2:P. O. BOX 1100
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1826
Mailing Address - Country:US
Mailing Address - Phone:417-257-6762
Mailing Address - Fax:417-257-5875
Practice Address - Street 1:1211 PORTER WAGONER BLVD # 23
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1826
Practice Address - Country:US
Practice Address - Phone:417-257-6762
Practice Address - Fax:417-257-5875
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ARP1006033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health