Basic Information
| Provider Information | |||||||||
| NPI: | 1063897320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 SIDNEY BAKER ST | ||||||||
| Address2: | 300 | ||||||||
| City: | KERRVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780282654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306342212 | ||||||||
| FaxNumber: | 8306342532 | ||||||||
| Practice Location | |||||||||
| Address1: | 417 LAKE SIDE CIR | ||||||||
| Address2: | |||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780065612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8304461295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2015 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 70320 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.