Provider Demographics
NPI:1639664113
Name:FOX, JERIMYA MATTHEW (LPC)
Entity Type:Individual
Prefix:DR
First Name:JERIMYA
Middle Name:MATTHEW
Last Name:FOX
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8559 N GAETANO LOOP
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-8500
Mailing Address - Country:US
Mailing Address - Phone:520-975-7946
Mailing Address - Fax:
Practice Address - Street 1:4621 N 1ST AVE STE 7
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5654
Practice Address - Country:US
Practice Address - Phone:520-975-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional