MEDICARE: SAMANTHA 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
1	101YM0800X	Mental Health Counselor	13408604-3502	UT

General Provider Information

NPI Number	:	1912707035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA COOK

Provider Business Mailing Address
First Line	:	5461 LUGE LN APT 2201
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-7646
Country	:	US
Telephone Number	:	919-417-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	5461 LUGE LN APT 2201
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-7646
Country	:	US
Telephone Number	:	919-417-3379
Fax Number	:

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

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/17/2025

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Directions to “ SAMANTHA COOK ” Practice Location

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