Provider Demographics
NPI:1366231706
Name:FOX, CISSY (LPCA)
Entity type:Individual
Prefix:
First Name:CISSY
Middle Name:
Last Name:FOX
Suffix:
Gender:
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CLIFTON CV
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8923
Mailing Address - Country:US
Mailing Address - Phone:931-309-7615
Mailing Address - Fax:
Practice Address - Street 1:131 NAHM ST STE 9
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4362
Practice Address - Country:US
Practice Address - Phone:270-625-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY298855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health