Healthcare Provider Details

I. General information

NPI: 1346202900
Provider Name (Legal Business Name): JAMES EDWARD COOK M.S., M.F.T.1
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4283 PIEDMONT AVE SUITE A-3
OAKLAND CA
94611-4758
US

IV. Provider business mailing address

1385 DONNA ST
NOVATO CA
94947-4516
US

V. Phone/Fax

Practice location:
  • Phone: 510-928-5743
  • Fax:
Mailing address:
  • Phone: 415-898-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC30796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: