Healthcare Provider Details

I. General information

NPI: 1700699683
Provider Name (Legal Business Name): MILES JOSEPH COOK M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. MILES JOSEPH COOK

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 CAMERADO DR STE 200
CAMERON PARK CA
95682-7636
US

IV. Provider business mailing address

289 WATERFIELD DR
ROSEVILLE CA
95678-6101
US

V. Phone/Fax

Practice location:
  • Phone: 530-677-4404
  • Fax:
Mailing address:
  • Phone: 916-801-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT152807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: