Provider Demographics
NPI:1639406119
Name:FOX, MYLINDA (BHRS)
Entity Type:Individual
Prefix:
First Name:MYLINDA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11657 COUNTY ROAD 1510
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-6605
Mailing Address - Country:US
Mailing Address - Phone:580-235-6283
Mailing Address - Fax:
Practice Address - Street 1:605 EAST 12TH
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6605
Practice Address - Country:US
Practice Address - Phone:580-436-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling