Provider Demographics
NPI:1558675587
Name:FOX, CRYSTAL KATTIE (BA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:KATTIE
Last Name:FOX
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1928
Mailing Address - Country:US
Mailing Address - Phone:972-932-4637
Mailing Address - Fax:972-932-4673
Practice Address - Street 1:106 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1928
Practice Address - Country:US
Practice Address - Phone:972-932-4637
Practice Address - Fax:972-932-4673
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker