Provider Demographics
NPI:1912078379
Name:MARSHALL FOX, SHARILYN (MFT)
Entity Type:Individual
Prefix:
First Name:SHARILYN
Middle Name:
Last Name:MARSHALL FOX
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SHARILYN
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951-0555
Mailing Address - Country:US
Mailing Address - Phone:707-337-3631
Mailing Address - Fax:
Practice Address - Street 1:555 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5064
Practice Address - Country:US
Practice Address - Phone:707-337-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist