Provider Demographics
NPI:1679199376
Name:FOX PROFESSIONAL COUNSELING LLC
Entity type:Organization
Organization Name:FOX PROFESSIONAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-432-6082
Mailing Address - Street 1:7970 EVELYN CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-5130
Mailing Address - Country:US
Mailing Address - Phone:321-432-6080
Mailing Address - Fax:
Practice Address - Street 1:166 CENTER ST STE 203A
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-3743
Practice Address - Country:US
Practice Address - Phone:321-432-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health