Provider Demographics
NPI:1972858603
Name:COX, IVAN WILLIAM ROBERT (LCSW, LPC)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:WILLIAM ROBERT
Last Name:COX
Suffix:
Gender:M
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21360 FM 487
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TX
Mailing Address - Zip Code:76511-4123
Mailing Address - Country:US
Mailing Address - Phone:254-527-3276
Mailing Address - Fax:
Practice Address - Street 1:21360 FM 487
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TX
Practice Address - Zip Code:76511-4123
Practice Address - Country:US
Practice Address - Phone:254-527-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5834101YP2500X
TX56581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional