Provider Demographics
NPI:1225674385
Name:COX, CRYSTAL (MED, LPC, RPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:MED, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78104-0161
Mailing Address - Country:US
Mailing Address - Phone:361-350-8088
Mailing Address - Fax:
Practice Address - Street 1:1004 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-3929
Practice Address - Country:US
Practice Address - Phone:361-350-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty