Provider Demographics
NPI:1891763322
Name:COX, BONNIE LEE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LEE
Last Name:COX
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HUDSON DR NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4220
Mailing Address - Country:US
Mailing Address - Phone:850-664-7855
Mailing Address - Fax:
Practice Address - Street 1:4449 STRAIGHT LINE RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6720
Practice Address - Country:US
Practice Address - Phone:850-699-1137
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 0002731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health