Healthcare Provider Details

I. General information

NPI: 1669395588
Provider Name (Legal Business Name): NATHAN TIMOTHY FOX LAC, MA, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 KINGS HWY S
CHERRY HILL NJ
08034-2512
US

IV. Provider business mailing address

845 BRIDGEBORO ST
RIVERSIDE NJ
08075-3436
US

V. Phone/Fax

Practice location:
  • Phone: 856-509-5418
  • Fax: 609-283-0025
Mailing address:
  • Phone: 856-394-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00837100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: