Provider Demographics
NPI:1720889645
Name:COX, SHANNON (MA, LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:COX
Suffix:
Gender:
Credentials:MA, LPC
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 129
Mailing Address - Street 2:
Mailing Address - City:TRANQUILITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07879-0129
Mailing Address - Country:US
Mailing Address - Phone:862-284-7187
Mailing Address - Fax:
Practice Address - Street 1:39 KENNEDY RD
Practice Address - Street 2:STE 39A
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-0782
Practice Address - Country:US
Practice Address - Phone:862-284-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01119900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional