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NPI Code Detail

MEDICARE: MRS. TANYA M FOX LAC

MEDICARE:  MRS. TANYA M FOX  LAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1496ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1024972OTHERBCBS OF ND

General Provider Information

NPI Number : 1700813029
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TANYA M FOX LAC
Provider Business Mailing Address
First Line : 316 2ND AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-1266
Country : US
Telephone Number : 701-774-4697
Fax Number : 701-774-4620
Provider Business Practice Location Address
First Line : 316 2ND AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-5218
Country : US
Telephone Number : 701-774-4697
Fax Number : 701-774-4620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 02/25/2009

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Directions to “ MRS. TANYA M FOX LAC” Practice Location

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