Provider Demographics
NPI:1811478464
Name:KOUMBIS, ANASTASIA (LSW)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:KOUMBIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31979 N FISH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9517
Mailing Address - Country:US
Mailing Address - Phone:847-546-6450
Mailing Address - Fax:847-546-0484
Practice Address - Street 1:31979 N FISH LAKE RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-9517
Practice Address - Country:US
Practice Address - Phone:847-201-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150102755104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker