Provider Demographics
NPI:1295491561
Name:FOX, ANISSA MAY (LPC)
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:MAY
Last Name:FOX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 S LAKESHORE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7046
Mailing Address - Country:US
Mailing Address - Phone:480-462-4277
Mailing Address - Fax:
Practice Address - Street 1:4535 S LAKESHORE DR STE 6
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7046
Practice Address - Country:US
Practice Address - Phone:480-462-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health