Provider Demographics
NPI:1851443741
Name:FOX, BRYAN (PHD)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:FOX
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DULANEY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7418
Mailing Address - Country:US
Mailing Address - Phone:803-422-2154
Mailing Address - Fax:
Practice Address - Street 1:2744 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1221
Practice Address - Country:US
Practice Address - Phone:803-999-2304
Practice Address - Fax:803-422-2154
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional