MEDICARE: MRS. ALICIA DIANE COX LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	121505	CA

General Provider Information

NPI Number	:	1073112769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICIA DIANE COX LMFT

Provider Business Mailing Address
First Line	:	3941 PARK DR STE 20
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4577
Country	:	US
Telephone Number	:	916-715-6826
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-9009
Country	:	US
Telephone Number	:	916-586-0062
Fax Number	:	916-542-2835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	12/14/2020

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