Organization
FOX CLINICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICK COSTAKIS PSYD (PRESIDENT)
(630) 776-9095
Entity
Organization
Contact information
Practice address
116 CRISSEY AVE, GENEVA, IL 60134-2809
(630) 776-9095
Mailing address
116 CRISSEY AVE, GENEVA, IL 60134-2809
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071008556
IL
Other
Enumeration date
03/11/2017
Last updated
03/11/2017
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