Provider Demographics
NPI:1871312330
Name:FOX, SAMANTHA (MFCC)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 BRIGHTON WAY
Mailing Address - Street 2:#302
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5131
Mailing Address - Country:US
Mailing Address - Phone:310-278-4330
Mailing Address - Fax:818-788-1194
Practice Address - Street 1:9615 BRIGHTON WAY
Practice Address - Street 2:#302
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5131
Practice Address - Country:US
Practice Address - Phone:310-278-4330
Practice Address - Fax:818-788-1194
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist