Provider Demographics
NPI:1679675714
Name:COX, VICTOREAN L (MS LLP)
Entity Type:Individual
Prefix:
First Name:VICTOREAN
Middle Name:L
Last Name:COX
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:MISS
Other - First Name:VICTOREAN
Other - Middle Name:L
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LLPPL
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3405 WESTWOOD PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-4686
Practice Address - Country:US
Practice Address - Phone:810-232-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361000885103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist