=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346657707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIKAKO INOUE COX PH D LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2014
-----------------------------------------------------
Last Update Date | 04/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3805 N HIGH ST STE 304
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-725-9134
-----------------------------------------------------
Fax | 888-615-5469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3805 N HIGH ST STE 304
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-725-9134
-----------------------------------------------------
Fax | 888-615-5469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | CHIKAKO INOUE COX
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 614-725-9134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 4335
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------