Provider Demographics
NPI:1225154982
Name:COX, CAROL PAXTON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:PAXTON
Last Name:COX
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28357 W STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-9009
Mailing Address - Country:US
Mailing Address - Phone:847-587-2422
Mailing Address - Fax:
Practice Address - Street 1:100 S ATKINSON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7817
Practice Address - Country:US
Practice Address - Phone:847-309-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004932571Medicare UPIN