Provider Demographics
NPI:1093170748
Name:FOX, JAMES WAYNE (BAS, T-LAC, PCCM,)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WAYNE
Last Name:FOX
Suffix:
Gender:M
Credentials:BAS, T-LAC, PCCM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3412
Mailing Address - Country:US
Mailing Address - Phone:785-266-0202
Mailing Address - Fax:785-267-3439
Practice Address - Street 1:4015 SE 21 ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604
Practice Address - Country:US
Practice Address - Phone:785-266-0202
Practice Address - Fax:786-267-3439
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LAC 1361101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)