Individual provider Active NPI

Douglas Stewart Fox

  • Professional Counselor
  • Johnson City, TN
National Provider Identifier
1407096746
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2427 Issued in TN
Practice address
3305 Victoria CT
Johnson City, TN 37604-2201
Phone
(423) 502-4158
NPI assigned
Feb 26, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 2427 TN Primary

Addresses

Primary practice location

3305 Victoria CT
Johnson City, TN 37604-2201

Mailing address

3305 Victoria CT
Johnson City, TN 37604-2201
Phone (423) 502-4158

Other identifiers 1

IdentifierTypeStateIssuer
1407096746MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240404002624 TN Practitioner - Mental Health Counselor 8820435258 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Choice Counseling, LLC Professional CurrentSince Jan 30, 2024 Accepting new patients

Locations

1416 S Roan St
Johnson City, TN 37601
Phone (423) 929-9959

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1407096746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 VICTORIA CT",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042201",
            "telephone_number": "423-502-4158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 VICTORIA CT",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042201",
            "telephone_number": "423-502-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOX",
        "first_name": "DOUGLAS",
        "middle_name": "STEWART",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-26",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "2427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407096746",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.