Provider Demographics
NPI:1417022369
Name:COX, DARREN D
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:D
Last Name:COX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-0574
Mailing Address - Country:US
Mailing Address - Phone:715-939-1393
Mailing Address - Fax:
Practice Address - Street 1:329 S RIVER ST # 301
Practice Address - Street 2:ANCHOR BAY COUNSELING CENTER LLC
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-9726
Practice Address - Country:US
Practice Address - Phone:715-939-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3433-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40980600Medicaid