Provider Demographics
NPI:1841656378
Name:COX, KRISTINA
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
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 1:19485 BEAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9332
Mailing Address - Country:US
Mailing Address - Phone:937-243-8460
Mailing Address - Fax:
Practice Address - Street 1:1375 US HIGHWAY 42 SE
Practice Address - Street 2:SUITE C
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9548
Practice Address - Country:US
Practice Address - Phone:740-845-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1400288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional