Healthcare Provider Details

I. General information

NPI: 1215408505
Provider Name (Legal Business Name): YARMESHIA MARSHA FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 KIRKLIN ST.
PAULINA LA
70763-1264
US

IV. Provider business mailing address

3245 KIRKLIN ST. #1264 P O BOX 1264
GRAMERCY LA
70052-1264
US

V. Phone/Fax

Practice location:
  • Phone: 662-425-2512
  • Fax:
Mailing address:
  • Phone: 662-425-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: