Provider Demographics
NPI:1669837498
Name:COX, GREGORY (LCSW)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:COX
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W148N9992 RIMROCK RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6128
Mailing Address - Country:US
Mailing Address - Phone:262-573-9902
Mailing Address - Fax:
Practice Address - Street 1:313 PRICE PL STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3262
Practice Address - Country:US
Practice Address - Phone:262-573-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32110101YA0400X
IL149.0184251041C0700X
WI9199-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)