Provider Demographics
NPI:1508067000
Name:COX, GLENDON KEITH (DMIN)
Entity Type:Individual
Prefix:DR
First Name:GLENDON
Middle Name:KEITH
Last Name:COX
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SOUTH COVENRTY DR.
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3262
Mailing Address - Country:US
Mailing Address - Phone:765-642-3363
Mailing Address - Fax:
Practice Address - Street 1:111 S COVENTRY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3262
Practice Address - Country:US
Practice Address - Phone:765-642-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000591A101YM0800X
IN34002299A1041C0700X
IN35000035A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist