Provider Demographics
NPI:1124288535
Name:FOX, COURTNEY R
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
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 1:75 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-5326
Mailing Address - Country:US
Mailing Address - Phone:805-512-7564
Mailing Address - Fax:
Practice Address - Street 1:75 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-5326
Practice Address - Country:US
Practice Address - Phone:805-512-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health