Provider Demographics
NPI:1538366620
Name:COX, JOHNNIE G (MHR, CM)
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:G
Last Name:COX
Suffix:
Gender:F
Credentials:MHR, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-3139
Mailing Address - Country:US
Mailing Address - Phone:918-832-7763
Mailing Address - Fax:918-832-7765
Practice Address - Street 1:711 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-3139
Practice Address - Country:US
Practice Address - Phone:918-832-7763
Practice Address - Fax:918-832-7765
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200563960AMedicaid