Individual
MR. COSTA PROVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.P.C.
Contact information
Practice address
444 N MICHIGAN AVE, CHICAGO, IL 60611-3903
(847) 529-8607
Mailing address
9430 OZARK AVE, MORTON GROVE, IL 60053-1063
(847) 529-8607
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
Other
Enumeration date
08/30/2007
Last updated
08/30/2007
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