Provider Demographics
NPI:1770975021
Name:FOX, BETH LORI (MFTI)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:LORI
Last Name:FOX
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:LORI
Other - Last Name:LOTTERSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7867 MELVIN AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1608
Mailing Address - Country:US
Mailing Address - Phone:310-926-8774
Mailing Address - Fax:818-885-5171
Practice Address - Street 1:16360 ROSCOE BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1219
Practice Address - Country:US
Practice Address - Phone:818-901-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF99083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist