Provider Demographics
NPI:1740785641
Name:COX, TRAVIS M (BCBA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:M
Last Name:COX
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PICO BLVD # 3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1177
Mailing Address - Country:US
Mailing Address - Phone:310-314-5201
Mailing Address - Fax:
Practice Address - Street 1:400 PICO BLVD # 3
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1177
Practice Address - Country:US
Practice Address - Phone:310-314-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-29220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst