Provider Demographics
NPI:1609632728
Name:CONVEY, FOX AVEN (MA)
Entity Type:Individual
Prefix:
First Name:FOX
Middle Name:AVEN
Last Name:CONVEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 SE MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-0652
Mailing Address - Country:US
Mailing Address - Phone:210-551-4707
Mailing Address - Fax:
Practice Address - Street 1:6002 SE MORRIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-0652
Practice Address - Country:US
Practice Address - Phone:210-551-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health