Provider Demographics
NPI:1558098012
Name:FOX FERN ADHD CLINIC PLLC
Entity Type:Organization
Organization Name:FOX FERN ADHD CLINIC PLLC
Other - Org Name:FOX FERN ADHD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRIFFITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:425-477-9101
Mailing Address - Street 1:2337 148TH AVE NE # 1206
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3733
Mailing Address - Country:US
Mailing Address - Phone:425-477-9010
Mailing Address - Fax:425-577-6545
Practice Address - Street 1:2337 148TH AVE NE # 1206
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3733
Practice Address - Country:US
Practice Address - Phone:425-477-9010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)