Provider Demographics
NPI:1942669643
Name:COX, LAURA (CDP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 S TERWILLEGER PR SE
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-8520
Mailing Address - Country:US
Mailing Address - Phone:509-492-8591
Mailing Address - Fax:
Practice Address - Street 1:8514 W GAGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8108
Practice Address - Country:US
Practice Address - Phone:509-396-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60099073101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)