Provider Demographics
NPI:1336509165
Name:COX, LILLIAN M (ADMINISTRATOR)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:M
Last Name:COX
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S MAIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-2961
Mailing Address - Country:US
Mailing Address - Phone:469-262-6053
Mailing Address - Fax:
Practice Address - Street 1:136 S MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-2961
Practice Address - Country:US
Practice Address - Phone:469-262-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health