Healthcare Provider Details

I. General information

NPI: 1336465640
Provider Name (Legal Business Name): MICHELE ANN FOX MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 GOLD ST
REDDING CA
96001-1937
US

IV. Provider business mailing address

1401 GOLD ST
REDDING CA
96001-1937
US

V. Phone/Fax

Practice location:
  • Phone: 530-319-7066
  • Fax: 530-319-7061
Mailing address:
  • Phone: 530-319-7066
  • Fax: 530-319-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 62786
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: