Provider Demographics
NPI:1790992204
Name:COX, MARY O (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:O
Last Name:COX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 S SYCAMORE ST
Mailing Address - Street 2:P O BOX 884
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5041
Mailing Address - Country:US
Mailing Address - Phone:903-729-7783
Mailing Address - Fax:
Practice Address - Street 1:1011 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5041
Practice Address - Country:US
Practice Address - Phone:903-729-7783
Practice Address - Fax:903-729-1330
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22638103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01341760-01Medicaid
TX00JD91Medicare ID - Type Unspecified