Provider Demographics
NPI:1518117415
Name:FOX, BETH CARYL (M A, MFT)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:CARYL
Last Name:FOX
Suffix:
Gender:F
Credentials:M A, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4202
Mailing Address - Country:US
Mailing Address - Phone:707-303-3210
Mailing Address - Fax:707-526-8310
Practice Address - Street 1:659 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4202
Practice Address - Country:US
Practice Address - Phone:707-303-3210
Practice Address - Fax:707-526-8310
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist