Provider Demographics
NPI:1992829089
Name:FOX, PATRICIA LOUISE (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:FOX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 PHEASANT RUN CIR
Mailing Address - Street 2:#7
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2460
Mailing Address - Country:US
Mailing Address - Phone:734-973-8266
Mailing Address - Fax:
Practice Address - Street 1:425 E WASHINGTON ST
Practice Address - Street 2:SUITE 206N
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2024
Practice Address - Country:US
Practice Address - Phone:734-973-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical