Provider Demographics
NPI:1639558042
Name:FOX, JEREMY GLENN (MA; LPC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:GLENN
Last Name:FOX
Suffix:
Gender:M
Credentials:MA; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MAXWELL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2045
Mailing Address - Country:US
Mailing Address - Phone:720-608-9863
Mailing Address - Fax:
Practice Address - Street 1:314 MAXWELL RD STE 400
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2045
Practice Address - Country:US
Practice Address - Phone:720-608-9863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO.0013351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health