Provider Demographics
NPI:1306372180
Name:BLOOMFIELD-FOX, BETH ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:BLOOMFIELD-FOX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6720 E ENSENADA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6053
Mailing Address - Country:US
Mailing Address - Phone:480-294-8843
Mailing Address - Fax:
Practice Address - Street 1:1234 S POWER RD STE 250
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3742
Practice Address - Country:US
Practice Address - Phone:480-630-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional