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General NPI Number Information
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NPI Number | 1134406507
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Entity Type | Individual
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Provider Name | JOHN WILLIAM FOX JR. LMHC
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Gender | Male
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Dates
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Enumeration Date | 11/13/2011
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 166 CENTER ST STE 203A
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-3743
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Country | US
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Telephone | 321-432-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 7970 EVELYN CT
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-5130
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Country | US
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Telephone | 352-989-7306
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH10639
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License Number State | FL
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