Provider Demographics
NPI:1891783742
Name:FOX, JIM (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:ROBERT
Other - Last Name:BELLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2737 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2212
Mailing Address - Country:US
Mailing Address - Phone:619-260-0414
Mailing Address - Fax:619-276-3527
Practice Address - Street 1:1761 HOTEL CIR S
Practice Address - Street 2:STE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3318
Practice Address - Country:US
Practice Address - Phone:619-260-0414
Practice Address - Fax:619-276-3527
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT7543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist