Provider Demographics
NPI:1538791058
Name:COX, TRINA WILLETTA
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:WILLETTA
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 1:3415 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3332
Mailing Address - Country:US
Mailing Address - Phone:414-254-3155
Mailing Address - Fax:414-797-4061
Practice Address - Street 1:7816 W BENDER AVE APT 1
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-1127
Practice Address - Country:US
Practice Address - Phone:414-797-4061
Practice Address - Fax:414-797-4061
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service