MEDICARE: DELORES GILMER COX M.ED, LPC

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	101YP2500X	Professional Counselor	2833	SC

General Provider Information

NPI Number	:	1366512790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELORES GILMER COX M.ED, LPC

Provider Business Mailing Address
First Line	:	143 MOURNING DOVE DR
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-7410
Country	:	US
Telephone Number	:	843-449-3086
Fax Number	:	843-449-5090

Provider Business Practice Location Address
First Line	:	1113 48TH AVE N
Second Line	:	SUITE 117
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5441
Country	:	US
Telephone Number	:	843-449-3086
Fax Number	:	843-449-5090

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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