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General NPI Number Information
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NPI Number | 1093170748
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Entity Type | Individual
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Provider Name | JAMES WAYNE FOX BAS, T-LAC, PCCM,
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Gender | Male
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 4015 SE 21 ST
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City | TOPEKA
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State | KS
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Zip | 66604
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Country | US
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Telephone | 785-266-0202
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Fax | 786-267-3439
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Provider Business Mailing Address
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Address Line | 4015 SW 21ST ST
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City | TOPEKA
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State | KS
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Zip | 66604-3412
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Country | US
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Telephone | 785-266-0202
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Fax | 785-267-3439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T-LAC 1361
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License Number State | KS
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