Organization
FOSTER PARK COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY C MARSHALL JOHNSON LMHCA (COUNSELOR/OWNER)
(260) 444-7200
Entity
Organization
Contact information
Practice address
1027 W RUDISILL BLVD STE 207, FORT WAYNE, IN 46807-2160
(260) 444-7200
Mailing address
1027 W RUDISILL BLVD STE 207, FORT WAYNE, IN 46807-2160
(260) 347-3280
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811533128
—
IN
Enumeration date
03/02/2022
Last updated
03/02/2022
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