Healthcare Provider Details

I. General information

NPI: 1942005384
Provider Name (Legal Business Name): BRANDIANNE COOK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 CYPRESS FOREST LN
SAINT CLOUD FL
34772-7211
US

IV. Provider business mailing address

4770 CYPRESS FOREST LN
SAINT CLOUD FL
34772-7211
US

V. Phone/Fax

Practice location:
  • Phone: 812-249-3951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20043137B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2024037364
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: