Provider Demographics
NPI:1033448659
Name:FOX, RENEE THERESA (LMHC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:THERESA
Last Name:FOX
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4554
Mailing Address - Country:US
Mailing Address - Phone:904-874-4907
Mailing Address - Fax:877-768-4670
Practice Address - Street 1:2577 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4554
Practice Address - Country:US
Practice Address - Phone:904-874-4907
Practice Address - Fax:877-768-4670
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health