Provider Demographics
NPI:1760055982
Name:FOX, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MAIN ST UNIT 173
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-3108
Mailing Address - Country:US
Mailing Address - Phone:502-716-2819
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN ST UNIT 173
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-3108
Practice Address - Country:US
Practice Address - Phone:502-716-2819
Practice Address - Fax:502-410-1973
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty