MEDICARE: MR. JOHN MARSHALL FOX LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701003396	VA

General Provider Information

NPI Number	:	1336340876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MARSHALL FOX LPC

Provider Business Mailing Address
First Line	:	11260 CHESTNUT GROVE SQ APT 340
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-5150
Country	:	US
Telephone Number	:	703-787-8672
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 HERNDON PKWY STE 201
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-4468
Country	:	US
Telephone Number	:	703-787-8526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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