Healthcare Provider Details

I. General information

NPI: 1548123771
Provider Name (Legal Business Name): MIRANDA COOK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7351 E LOWRY BLVD STE 200
DENVER CO
80230-6083
US

IV. Provider business mailing address

3037 S VALENTIA ST
DENVER CO
80231-4216
US

V. Phone/Fax

Practice location:
  • Phone: 877-825-8584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0009927022
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: