Provider Demographics
NPI:1316428592
Name:FOX, KATHLEEN JOAN (LMFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JOAN
Last Name:FOX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JOAN O'BRIEN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1800 N. GRAVENSTEIN HWY
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 N. GRAVENSTEIN HWY
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-634-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF96904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist