MEDICARE: MICHAEL NUNAN COOK LCPC

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	180.017136	IL

General Provider Information

NPI Number	:	1538822697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL NUNAN COOK LCPC

Provider Business Mailing Address
First Line	:	1817 10TH FAIRWAY DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-4867
Country	:	US
Telephone Number	:	618-954-9523
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 WOLF CREEK DR STE 3
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2367
Country	:	US
Telephone Number	:	618-954-9523
Fax Number	:

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

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	02/13/2026

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