Healthcare Provider Details

I. General information

NPI: 1508192477
Provider Name (Legal Business Name): BRIANA FOX MS, LPC, CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 NE COURTNEY DR
BEND OR
97701-7752
US

IV. Provider business mailing address

2577 NE COURTNEY DR
BEND OR
97701-7752
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-4612
  • Fax:
Mailing address:
  • Phone: 541-330-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13-03-19
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3575
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: