Provider Demographics
NPI:1528578937
Name:FOX, SHELBY KAY
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:KAY
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11646 S WINN RD
Mailing Address - Street 2:
Mailing Address - City:VESTABURG
Mailing Address - State:MI
Mailing Address - Zip Code:48891-9600
Mailing Address - Country:US
Mailing Address - Phone:989-866-6539
Mailing Address - Fax:
Practice Address - Street 1:3508 S WYMAN RD
Practice Address - Street 2:
Practice Address - City:REMUS
Practice Address - State:MI
Practice Address - Zip Code:49340-9603
Practice Address - Country:US
Practice Address - Phone:989-317-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MIBACB607169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other