Healthcare Provider Details

I. General information

NPI: 1396676938
Provider Name (Legal Business Name): ROBERT J FOX MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 RIVERSIDE DR
MONROE LA
71201-6211
US

IV. Provider business mailing address

415 GULPHA DR APT 22
WEST MONROE LA
71291-4639
US

V. Phone/Fax

Practice location:
  • Phone: 318-398-0945
  • Fax:
Mailing address:
  • Phone: 318-450-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: