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General NPI Number Information
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NPI Number | 1558098012
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Entity Type | Organization
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Legal Business Name | FOX FERN ADHD CLINIC PLLC
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 2337 148TH AVE NE # 1206
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City | BELLEVUE
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State | WA
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Zip | 98007-3733
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Country | US
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Telephone | 425-477-9010
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Fax |
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Provider Business Mailing Address
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Address Line | 2337 148TH AVE NE # 1206
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City | BELLEVUE
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State | WA
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Zip | 98007-3733
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Country | US
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Telephone | 425-477-9010
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Fax | 425-577-6545
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Authorized Official
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Title or Position | OWNER
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Name | GRIFFITH JONES
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Credential | PA-C
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Telephone | 425-477-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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