Provider Demographics
NPI:1598399909
Name:COX, TALISSA LECINUE (RBT)
Entity Type:Individual
Prefix:
First Name:TALISSA
Middle Name:LECINUE
Last Name:COX
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8307 ROYAL SAND CIR APT 209
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1590
Mailing Address - Country:US
Mailing Address - Phone:813-557-9128
Mailing Address - Fax:
Practice Address - Street 1:8307 ROYAL SAND CIR APT 209
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1590
Practice Address - Country:US
Practice Address - Phone:813-557-9128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-112256106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician