Provider Demographics
NPI:1578894440
Name:FOX, RODERICK KINGSBURY (BCBA)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:KINGSBURY
Last Name:FOX
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 NASHBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-4859
Mailing Address - Country:US
Mailing Address - Phone:734-649-6126
Mailing Address - Fax:615-760-5817
Practice Address - Street 1:1139 WOODRIDGE PL
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4510
Practice Address - Country:US
Practice Address - Phone:615-310-6151
Practice Address - Fax:615-288-4943
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst