Provider Demographics
NPI:1720109754
Name:FOX-AVNET, JO ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:JO ANNE
Middle Name:
Last Name:FOX-AVNET
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 1:15315 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1173
Mailing Address - Country:US
Mailing Address - Phone:818-789-5202
Mailing Address - Fax:818-789-4787
Practice Address - Street 1:15315 MAGNOLIA BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1173
Practice Address - Country:US
Practice Address - Phone:818-789-5202
Practice Address - Fax:818-789-4787
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM14620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist