Provider Demographics
NPI:1750650594
Name:FOX, MICHAEL ROBERT (MPS, ATR-BC, LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:FOX
Suffix:
Gender:M
Credentials:MPS, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ROSE ALY
Mailing Address - Street 2:PO BOX 4035
Mailing Address - City:SELTZER
Mailing Address - State:PA
Mailing Address - Zip Code:17901
Mailing Address - Country:US
Mailing Address - Phone:570-449-4088
Mailing Address - Fax:
Practice Address - Street 1:116 ROSE ALLEY
Practice Address - Street 2:
Practice Address - City:SELTZER
Practice Address - State:PA
Practice Address - Zip Code:17974
Practice Address - Country:US
Practice Address - Phone:570-449-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health