Provider Demographics
NPI:1417425562
Name:FOX, ADAM RAYMONDS (EDS SCHOOL PSYC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RAYMONDS
Last Name:FOX
Suffix:
Gender:M
Credentials:EDS SCHOOL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5505
Mailing Address - Country:US
Mailing Address - Phone:740-354-7761
Mailing Address - Fax:740-354-6778
Practice Address - Street 1:1 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-1225
Practice Address - Country:US
Practice Address - Phone:740-384-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3151557103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool