Provider Demographics
NPI:1215092937
Name:JACOX, CYNTHIA (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:JACOX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17121 SE 270TH PL
Mailing Address - Street 2:STE #205
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5431
Mailing Address - Country:US
Mailing Address - Phone:253-638-7475
Mailing Address - Fax:253-638-7465
Practice Address - Street 1:17121 SE 270TH PL
Practice Address - Street 2:STE #205
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5431
Practice Address - Country:US
Practice Address - Phone:253-638-7475
Practice Address - Fax:253-638-7465
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00027939101Y00000X
WAPY00002069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8917777OtherCRIME VICTIMS NUMBER
WA111940OtherL & I NUMBER
WA111940OtherL & I NUMBER