Provider Demographics
NPI:1154500858
Name:FOXWORTHY, DESIREE V (LMFT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:V
Last Name:FOXWORTHY
Suffix:
Gender:F
Credentials:LMFT
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 7172
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-7172
Mailing Address - Country:US
Mailing Address - Phone:831-429-8360
Mailing Address - Fax:
Practice Address - Street 1:520 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3611
Practice Address - Country:US
Practice Address - Phone:831-295-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC39450OtherBOARD BEHAVIORAL SCIENCES