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NPI Code Detail

MEDICARE: AVERY BANKS COOK

MEDICARE: AVERY BANKS COOK
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
141871432DOTHERLAA HAND IN NEED

General Provider Information

NPI Number : 1568986743
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY BANKS COOK
Provider Business Mailing Address
First Line : 660 NEW RAFE MEYER RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70807-1134
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15049 FLORIDA BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70819-2602
Country : US
Telephone Number : 225-775-0779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2017
Last Update Date : 06/16/2018

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Directions to “ AVERY BANKS COOK ” Practice Location

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