Provider Demographics
NPI:1982148722
Name:FOSTER, TIMOTHY RYAN (LPC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:RYAN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-7102
Mailing Address - Country:US
Mailing Address - Phone:715-577-9397
Mailing Address - Fax:
Practice Address - Street 1:800 WISCONSIN ST
Practice Address - Street 2:BLDG D02 STE 405B
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703
Practice Address - Country:US
Practice Address - Phone:715-600-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7368-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional