Provider Demographics
NPI:1013785161
Name:FOX, TAYLOR ELISE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELISE
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 KENNETT AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2923
Mailing Address - Country:US
Mailing Address - Phone:563-599-9652
Mailing Address - Fax:
Practice Address - Street 1:1231 KENNETT AVE APT 3
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2923
Practice Address - Country:US
Practice Address - Phone:563-599-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician