Provider Demographics
NPI:1861610362
Name:COX, BRIAN GARRETT (LCSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:GARRETT
Last Name:COX
Suffix:
Gender:M
Credentials:LCSW
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 1930
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-1806
Mailing Address - Country:US
Mailing Address - Phone:503-492-4492
Mailing Address - Fax:503-492-0855
Practice Address - Street 1:1450 NE VILLAGE ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-3827
Practice Address - Country:US
Practice Address - Phone:503-492-4492
Practice Address - Fax:503-492-0855
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR131762Medicare PIN