Individual
TYRA JEAN RUSSELL FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
315 ALAMEDA BLVD NE STE A, ALBUQUERQUE, NM 87113-2155
(505) 220-5809
(505) 856-7946
Mailing address
PO BOX 15454, RIO RANCHO, NM 87174-0454
(505) 220-5809
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CCMH0206181
NM
Other
Enumeration date
03/02/2016
Last updated
04/29/2020
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