Provider Demographics
NPI:1093022071
Name:FOX, COREY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:D
Last Name:FOX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6056 KENNETH OAK WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2673
Mailing Address - Country:US
Mailing Address - Phone:916-987-5686
Mailing Address - Fax:916-244-0129
Practice Address - Street 1:6056 KENNETH OAK WAY
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2673
Practice Address - Country:US
Practice Address - Phone:916-987-5686
Practice Address - Fax:916-244-0129
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-11
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33880103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth