Provider Demographics
NPI:1134406507
Name:FOX, JOHN WILLIAM JR (LMHC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIAM
Last Name:FOX
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7970 EVELYN CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-5130
Mailing Address - Country:US
Mailing Address - Phone:352-989-7306
Mailing Address - Fax:
Practice Address - Street 1:166 CENTER ST STE 203A
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-3743
Practice Address - Country:US
Practice Address - Phone:321-432-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-13
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10639101YM0800X
OK4620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health