Healthcare Provider Details

I. General information

NPI: 1275451288
Provider Name (Legal Business Name): CHANTELE MARIE FOX MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20956 MACK AVE
GROSSE POINTE WOODS MI
48236-1355
US

IV. Provider business mailing address

20956 MACK AVE
GROSSE POINTE WOODS MI
48236-1355
US

V. Phone/Fax

Practice location:
  • Phone: 313-451-1685
  • Fax:
Mailing address:
  • Phone: 313-451-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025099
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: