Provider Demographics
NPI:1467071720
Name:FOX, LEAH S (PSYCHOTHERAPIST)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:S
Last Name:FOX
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1822
Mailing Address - Country:US
Mailing Address - Phone:352-215-4969
Mailing Address - Fax:
Practice Address - Street 1:100 ARAPAHOE AVE STE 9
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5854
Practice Address - Country:US
Practice Address - Phone:720-442-0946
Practice Address - Fax:720-573-4926
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.01019982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical