Provider Demographics
NPI:1124404447
Name:BROOKE KAYMAN FOX, INC.
Entity Type:Organization
Organization Name:BROOKE KAYMAN FOX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:837-363-0582
Mailing Address - Street 1:950 SKOKIE BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4015
Mailing Address - Country:US
Mailing Address - Phone:847-363-0582
Mailing Address - Fax:
Practice Address - Street 1:950 SKOKIE BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4015
Practice Address - Country:US
Practice Address - Phone:847-363-0582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149009105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty