Provider Demographics
NPI:1538487145
Name:COX, TYWANDA MONIQUE (LADC UNDER SUPERVISI)
Entity Type:Individual
Prefix:
First Name:TYWANDA
Middle Name:MONIQUE
Last Name:COX
Suffix:
Gender:F
Credentials:LADC UNDER SUPERVISI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 WOODBEND LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6335
Mailing Address - Country:US
Mailing Address - Phone:405-885-2173
Mailing Address - Fax:405-530-3462
Practice Address - Street 1:1330 CLASSED BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106
Practice Address - Country:US
Practice Address - Phone:405-243-4252
Practice Address - Fax:405-530-3462
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)