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Organization
COPRO CLINICAL CONCEPTS, PC
Active
Organization
COPRO CLINICAL CONCEPTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COSTA D. PROVIS L.C.P.C. (PRESIDENT)
(847) 529-8607
Entity
Organization
Contact information
Practice address
4003 N BROADWAY ST, CHICAGO, IL 60613-2110
(847) 529-8607
Mailing address
1755 E CARIB LN, MOUNT PROSPECT, IL 60056-1703
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/02/2010
Last updated
09/02/2010
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