Provider Demographics
NPI:1255582334
Name:COX, JUNE ELLEN
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:ELLEN
Last Name:COX
Suffix:
Gender:F
Credentials:
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 283
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-0283
Mailing Address - Country:US
Mailing Address - Phone:208-339-8347
Mailing Address - Fax:
Practice Address - Street 1:343 E 4TH N
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1684
Practice Address - Country:US
Practice Address - Phone:208-339-8347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health