| Eric Foster, Inc. | |
|
322 West Jefferson St. Plymouth IN 46563-1734 | |
| (574) 936-3377 | |
| (574) 936-3910 |
| Full Name | Eric Foster, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 322 West Jefferson St., Plymouth, Indiana |
| Authorized Official Name and Position | Eric Wayne Foster (OWNER) |
| Authorized Official Contact | 5749363377 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eric Foster, Inc. 322 W Jefferson St Plymouth IN 46563-1734 Ph: (574) 936-3377 | Eric Foster, Inc. 322 West Jefferson St. Plymouth IN 46563-1734 Ph: (574) 936-3377 |
| NPI Number | 1437478864 |
|---|---|
| Provider Enumeration Date | 05/25/2010 |
| Last Update Date | 05/25/2010 |
| Medicare PECOS PAC ID | 7618280223 |
|---|---|
| Medicare Enrollment ID | O20150724010690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437478864 | NPI | - | NPPES |
| 200400060A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 39000890A (Indiana) | Primary |
| Provider Name | Nanette M Fredericks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871599761 PECOS PAC ID: 4486834231 Enrollment ID: I20110210000771 |
| Provider Name | Alicia Hulsey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518497726 PECOS PAC ID: 6709221195 Enrollment ID: I20240226000453 |
| Provider Name | Eric Foster |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922172261 PECOS PAC ID: 6709199318 Enrollment ID: I20240523003482 |
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