Provider Demographics
NPI:1033301106
Name:FOX, VICKY LYNN (CG/T-C)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:FOX
Suffix:
Gender:F
Credentials:CG/T-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752552
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38175-2552
Mailing Address - Country:US
Mailing Address - Phone:901-755-1856
Mailing Address - Fax:
Practice Address - Street 1:1325 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2013
Practice Address - Country:US
Practice Address - Phone:901-755-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor