Provider Demographics
NPI:1013121086
Name:COX, CHARLES LEROY (LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEROY
Last Name:COX
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:BURNA
Mailing Address - State:KY
Mailing Address - Zip Code:42028-0061
Mailing Address - Country:US
Mailing Address - Phone:270-331-3639
Mailing Address - Fax:
Practice Address - Street 1:1513 HWY 60
Practice Address - Street 2:
Practice Address - City:BURNA
Practice Address - State:KY
Practice Address - Zip Code:42028-0061
Practice Address - Country:US
Practice Address - Phone:270-331-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist