Provider Demographics
NPI:1770602740
Name:FOX, CINDY GORDON (LMFT)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:GORDON
Last Name:FOX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N 6TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5992
Mailing Address - Country:US
Mailing Address - Phone:208-429-1495
Mailing Address - Fax:208-429-1410
Practice Address - Street 1:106 N 6TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5992
Practice Address - Country:US
Practice Address - Phone:208-429-1495
Practice Address - Fax:208-429-1410
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT 3713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ7416OtherBLUE CROSS PROVIDER NUMBE