Basic Information
| Provider Information | |||||||||
| NPI: | 1588908115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | TOM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 W GOWE ST | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980325892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538337444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 655 S ORCAS ST | ||||||||
| Address2: | SUITE 122 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981082648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538337444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP00001472 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | LW00005419 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.