Healthcare Provider Details

I. General information

NPI: 1932512373
Provider Name (Legal Business Name): MICHELLE MARIE COOK EDD, LMFT, RPT-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8391 AUBURN BLVD
CITRUS HEIGHTS CA
95610-0364
US

IV. Provider business mailing address

PO BOX 952
ROSEVILLE CA
95661-0952
US

V. Phone/Fax

Practice location:
  • Phone: 916-923-5444
  • Fax:
Mailing address:
  • Phone: 858-882-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number99275
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99275
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number99275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: