Provider Demographics
NPI:1023199205
Name:FOX, MARA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:LYNN
Last Name:FOX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 171745
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-1745
Mailing Address - Country:US
Mailing Address - Phone:817-919-6957
Mailing Address - Fax:817-919-9287
Practice Address - Street 1:6421 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE 417
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5401
Practice Address - Country:US
Practice Address - Phone:817-919-6957
Practice Address - Fax:817-919-9287
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical