Provider Demographics
NPI:1689716946
Name:FOX, DANIEL BRYAN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRYAN
Last Name:FOX
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S FREYA ST STE 110D
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4878
Mailing Address - Country:US
Mailing Address - Phone:509-726-1011
Mailing Address - Fax:509-844-0165
Practice Address - Street 1:104 S FREYA ST STE 110D
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4878
Practice Address - Country:US
Practice Address - Phone:509-726-1011
Practice Address - Fax:509-844-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000073101041C0700X
FLLW0007310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8852345Medicare UPIN