{
"Npi": {
"NPI": "1730982570",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COX",
"FirstName": "THEODORE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MA, PLPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COX",
"OtherFirstName": "TEDDY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MA, PLPC",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "670 ALBEMARLE DR BLDG 7",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHREVEPORT",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71106-5945",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-562-6903",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2103 OLD MINDEN RD STE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOSSIER CITY",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "71112-2374",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "318-674-4222",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/28/2025",
"LastUpdateDate": "04/01/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "PLC10307",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}