Provider Demographics
NPI:1063687242
Name:COX, DEBORAH (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 CRENSHAW BLVD
Mailing Address - Street 2:300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1227
Mailing Address - Country:US
Mailing Address - Phone:323-290-8360
Mailing Address - Fax:323-766-2370
Practice Address - Street 1:4401 CRENSHAW BLVD
Practice Address - Street 2:300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1227
Practice Address - Country:US
Practice Address - Phone:323-290-8360
Practice Address - Fax:323-766-2370
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF53637225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner