1770602740 NPI number — MS. CINDY GORDON FOX LMFT

Table of content: MS. CINDY GORDON FOX LMFT (NPI 1770602740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770602740 NPI number — MS. CINDY GORDON FOX LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
CINDY
Provider Middle Name:
GORDON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770602740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 N 6TH ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83702-5992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-429-1495
Provider Business Mailing Address Fax Number:
208-429-1410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 N 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83702-5992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-429-1495
Provider Business Practice Location Address Fax Number:
208-429-1410
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LMFT 3713 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q7416 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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