Provider Demographics
NPI:1336465640
Name:FOX, MICHELE ANN (MA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:FOX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1937
Mailing Address - Country:US
Mailing Address - Phone:530-319-7066
Mailing Address - Fax:530-319-7061
Practice Address - Street 1:1401 GOLD ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1937
Practice Address - Country:US
Practice Address - Phone:530-319-7066
Practice Address - Fax:530-319-7061
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAIMF 62786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator