Healthcare Provider Details

I. General information

NPI: 1164937207
Provider Name (Legal Business Name): SUSAN FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GARFIELD AVE
BATTLE CREEK MI
49037-3407
US

IV. Provider business mailing address

411 ALLEN RD
MARSHALL MI
49068-1318
US

V. Phone/Fax

Practice location:
  • Phone: 269-962-3768
  • Fax:
Mailing address:
  • Phone: 269-986-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: