Provider Demographics
NPI:1629338298
Name:COX, MARY M (LISW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:COX
Suffix:
Gender:F
Credentials:LISW
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 290
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-0290
Mailing Address - Country:US
Mailing Address - Phone:567-241-1543
Mailing Address - Fax:419-702-0695
Practice Address - Street 1:380 CLINE AVE STE 3
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1056
Practice Address - Country:US
Practice Address - Phone:567-241-1543
Practice Address - Fax:419-702-0695
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI12004731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical