Provider Demographics
NPI:1811219777
Name:FOX-TOMASSI, JACQUELYN (CBT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:
Last Name:FOX-TOMASSI
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RONDA ANN LN
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-9645
Mailing Address - Country:US
Mailing Address - Phone:501-282-3427
Mailing Address - Fax:501-881-4785
Practice Address - Street 1:104 RONDA ANN LN
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71909-9645
Practice Address - Country:US
Practice Address - Phone:501-282-3427
Practice Address - Fax:501-881-4785
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374K00000X, 171M00000X
NC5210BT174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator