Provider Demographics
NPI:1346573128
Name:COX, THADDEUS MARTIN (LPC)
Entity Type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:MARTIN
Last Name:COX
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 BRODIE LANE 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7473
Mailing Address - Country:US
Mailing Address - Phone:415-812-0263
Mailing Address - Fax:512-282-2272
Practice Address - Street 1:8103 BRODIE LANE 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7473
Practice Address - Country:US
Practice Address - Phone:415-812-0263
Practice Address - Fax:512-282-2272
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62696101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional