Provider Demographics
NPI:1922496843
Name:FOX, LISA DIONNE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIONNE
Last Name:FOX
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7412
Mailing Address - Country:US
Mailing Address - Phone:615-881-1203
Mailing Address - Fax:866-936-1472
Practice Address - Street 1:1313 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7412
Practice Address - Country:US
Practice Address - Phone:615-881-1203
Practice Address - Fax:866-936-1472
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBACB26127103K00000X
TN1-14-17664103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst