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General NPI Number Information
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NPI Number | 1679199376
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Entity Type | Organization
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Legal Business Name | FOX PROFESSIONAL COUNSELING LLC
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 166 CENTER ST STE 203A
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-3743
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Country | US
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Telephone | 321-432-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 7970 EVELYN CT
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-5130
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Country | US
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Telephone | 321-432-6080
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN W FOX JR.
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Credential | LMHC
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Telephone | 321-432-6082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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