Provider Demographics
NPI:1063897320
Name:FOX, KEVIN LEE (LPC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:FOX
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SIDNEY BAKER ST
Mailing Address - Street 2:300
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2654
Mailing Address - Country:US
Mailing Address - Phone:830-634-2212
Mailing Address - Fax:830-634-2532
Practice Address - Street 1:417 LAKE SIDE CIR
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5612
Practice Address - Country:US
Practice Address - Phone:830-446-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional