MEDICARE: COOK N UP EXCELLENCE COLLECTIVE LLC

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	101YM0800X	Mental Health Counselor
2	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1467127035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOK N UP EXCELLENCE COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	2588 S DUKE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-8831
Country	:	US
Telephone Number	:	559-352-8036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2588 S DUKE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-8831
Country	:	US
Telephone Number	:	559-352-8036
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. CLARENE MARIE WHITE
Credential	:	APCC
Telephone Number	:	559-352-8036

Provider Enumeration Date	:	08/15/2021
Last Update Date	:	08/15/2021

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