MEDICARE: ALEXANDRA FOX LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180007685	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1396034724	OTHER	IL	ORGANIZATION NPI

General Provider Information

NPI Number	:	1689972341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA FOX LCPC

Provider Business Mailing Address
First Line	:	1420 N LAKE SHORE DR APT 12A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-6690
Country	:	US
Telephone Number	:	312-972-3666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 N LAKE SHORE DR APT 12A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-6690
Country	:	US
Telephone Number	:	312-972-3666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	07/16/2024

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