Provider Demographics
NPI:1972269264
Name:FOX, MAUREEN CARMEN (MED, EDS, LPC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:CARMEN
Last Name:FOX
Suffix:
Gender:F
Credentials:MED, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO 528
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647
Mailing Address - Country:US
Mailing Address - Phone:970-618-5170
Mailing Address - Fax:
Practice Address - Street 1:255 W CAPITAL COURT
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647
Practice Address - Country:US
Practice Address - Phone:970-618-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO293101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty