Basic Information
| Provider Information | |||||||||
| NPI: | 1770975021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | LORI | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MFTI | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LOTTERSTEIN | ||||||||
| OtherFirstName: | BETH | ||||||||
| OtherMiddleName: | LORI | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7867 MELVIN AVE | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913351608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109268774 | ||||||||
| FaxNumber: | 8188855171 | ||||||||
| Practice Location | |||||||||
| Address1: | 16360 ROSCOE BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914061219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014830 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2015 | ||||||||
| LastUpdateDate: | 10/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF99083 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.