Foster Park Counseling LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

FOSTER PARK COUNSELING LLC

Practice address

1027 W Rudisill Blvd Ste 207
Fort Wayne, IN 46807-2160

Phone

(260) 444-7200

NPI assigned

Mar 2, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracy C Marshall Johnson, LMHCANPI 1811533128

Title

Counselor/Owner

Phone

(260) 444-7200

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracy C Marshall-Johnson

  • Mental Health Counselor
  • Fort Wayne, IN
  • NPI 1811533128
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1407503238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 W RUDISILL BLVD STE 207",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468072160",
            "telephone_number": "260-347-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 W RUDISILL BLVD STE 207",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468072160",
            "telephone_number": "260-444-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOSTER PARK COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-02",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "MARSHALL JOHNSON",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "COUNSELOR/OWNER",
        "authorized_official_telephone_number": "260-444-7200",
        "authorized_official_credential": "LMHCA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811533128",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenifer Kay Fortney, PA-C
• Samantha A Fortune, RBT
• Erin Fosnaugh, HIS
• Carin Elisabeth Foss, NP-BC, RN
• Stephanie Foss
• Brooke Foster
• Jason Foster
• Nideo Foster, DPT, PT
• Richard Foster
• Susanne Foster

• Mental Health Clinic/Center (Including Community Mental Health Center) in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.