Provider Demographics
NPI:1487142733
Name:COX, KLARICE
Entity type:Individual
Prefix:
First Name:KLARICE
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 1:878 RAVENSWOOD ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-7252
Mailing Address - Country:US
Mailing Address - Phone:321-419-3920
Mailing Address - Fax:
Practice Address - Street 1:475 S JOHN RODES BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1093
Practice Address - Country:US
Practice Address - Phone:321-241-1170
Practice Address - Fax:321-241-1171
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty