Provider Demographics
NPI:1730982570
Name:COX, THEODORE (MA, PLPC)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:COX
Suffix:
Gender:
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:TEDDY
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, PLPC
Mailing Address - Street 1:670 ALBEMARLE DR BLDG 7
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-5945
Mailing Address - Country:US
Mailing Address - Phone:318-562-6903
Mailing Address - Fax:
Practice Address - Street 1:2103 OLD MINDEN RD STE C
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2374
Practice Address - Country:US
Practice Address - Phone:318-674-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health