MEDICARE: MRS. SHEILA DIANE 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	OK247	OK

General Provider Information

NPI Number	:	1942249180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEILA DIANE FOX LCSW

Provider Business Mailing Address
First Line	:	4334 N. W. EXPRESSWAY
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-4550
Country	:	US
Telephone Number	:	405-942-4308
Fax Number	:	405-942-6011

Provider Business Practice Location Address
First Line	:	4334 NW EXPRESSWAY ST
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1578
Country	:	US
Telephone Number	:	405-942-4308
Fax Number	:	405-942-6011

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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