Provider Demographics
NPI:1790242113
Name:COX, JEROME (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:COX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JEROME
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:657 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4748
Mailing Address - Country:US
Mailing Address - Phone:318-780-1401
Mailing Address - Fax:318-626-7064
Practice Address - Street 1:298 ARMY RD
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019-6111
Practice Address - Country:US
Practice Address - Phone:318-780-1401
Practice Address - Fax:318-626-7064
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral