Healthcare Provider Details

I. General information

NPI: 1134650492
Provider Name (Legal Business Name): MICHAEL STEPHEN FOX LICSW SUDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S JEFFERSON ST STE 100
SPOKANE WA
99204-3142
US

IV. Provider business mailing address

PO BOX 11674
SPOKANE VALLEY WA
99211-1674
US

V. Phone/Fax

Practice location:
  • Phone: 509-703-2156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61126878
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60647381
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9181110
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: