Healthcare Provider Details

I. General information

NPI: 1104755719
Provider Name (Legal Business Name): JUSTIN MATTHEW FOX BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 MEDICAL CENTER PKWY STE 1580A
MURFREESBORO TN
37129-2261
US

IV. Provider business mailing address

542 AMHERST ST STE B
NASHUA NH
03063-1016
US

V. Phone/Fax

Practice location:
  • Phone: 844-427-6319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2134
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: