Provider Demographics
NPI:1104958453
Name:FOX, THOMAS J (MED, LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:FOX
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 LACLEDE AVE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2248
Mailing Address - Country:US
Mailing Address - Phone:314-533-3567
Mailing Address - Fax:
Practice Address - Street 1:4390 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2248
Practice Address - Country:US
Practice Address - Phone:314-721-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional