Provider Demographics
NPI:1770752842
Name:FOX, BRENDA J (MS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:FOX
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 W PEORIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5211
Mailing Address - Country:US
Mailing Address - Phone:602-548-8508
Mailing Address - Fax:602-548-1201
Practice Address - Street 1:3101 W PEORIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5211
Practice Address - Country:US
Practice Address - Phone:602-548-8508
Practice Address - Fax:602-548-1201
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCATR-BC 02-202101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor