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NPI Code Detail

MEDICARE: KRYSTLE COOKE

MEDICARE: KRYSTLE COOKE
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

General Provider Information

NPI Number : 1578833349
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTLE COOKE
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number : 541-858-8170
Fax Number :
Provider Business Practice Location Address
First Line : 17640 NE HALSEY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97230-6733
Country : US
Telephone Number : 503-489-5045
Fax Number : 503-489-5638
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2012
Last Update Date : 10/05/2019

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Directions to “ KRYSTLE COOKE ” Practice Location

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