MEDICARE: CHRISTINA MARIE FOXHALL LCSW

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	1041C0700X	Clinical Social Worker	55463	TX

General Provider Information

NPI Number	:	1669038873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE FOXHALL LCSW

Provider Business Mailing Address
First Line	:	208 SHANT ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-1615
Country	:	US
Telephone Number	:	210-387-8897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 GROVE BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78741-3453
Country	:	US
Telephone Number	:	512-356-1580
Fax Number	:

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

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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