Individual
JENNIFER COX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
204 WALL ST STE A, POTEAU, OK 74953-4400
(918) 649-0018
Mailing address
1000 MEADOW LANE, HOWE, OK 74940
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100708350B
—
OK
Enumeration date
04/16/2014
Last updated
08/12/2024
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