Provider Demographics
NPI:1255793014
Name:COX, DIANNE CHEAH (MA, PCMHT)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:CHEAH
Last Name:COX
Suffix:
Gender:F
Credentials:MA, PCMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 SWINNEA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6380
Mailing Address - Country:US
Mailing Address - Phone:901-590-9790
Mailing Address - Fax:
Practice Address - Street 1:7145 SWINNEA RD STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6380
Practice Address - Country:US
Practice Address - Phone:901-590-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional