MEDICARE: MS. MARA LYNN FOX LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11602	TX

General Provider Information

NPI Number	:	1023199205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARA LYNN FOX LCSW

Provider Business Mailing Address
First Line	:	PO BOX 171745
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76003-1745
Country	:	US
Telephone Number	:	817-919-6957
Fax Number	:	817-919-9287

Provider Business Practice Location Address
First Line	:	6421 CAMP BOWIE BLVD
Second Line	:	SUITE 417
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5401
Country	:	US
Telephone Number	:	817-919-6957
Fax Number	:	817-919-9287

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/27/2014

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