Provider Demographics
NPI:1770628166
Name:COX, KATHLEEN EUNICE (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EUNICE
Last Name:COX
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9222
Mailing Address - Country:US
Mailing Address - Phone:815-324-0324
Mailing Address - Fax:866-927-3053
Practice Address - Street 1:5290 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9222
Practice Address - Country:US
Practice Address - Phone:815-494-0035
Practice Address - Fax:866-927-3053
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional