Healthcare Provider Details

I. General information

NPI: 1124801022
Provider Name (Legal Business Name): MELISSA R COOKE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 E CENTRAL AVE STE C
WICHITA KS
67206-1937
US

IV. Provider business mailing address

14601 E HAWTHORNE CT
WICHITA KS
67230-9646
US

V. Phone/Fax

Practice location:
  • Phone: 316-867-9852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5359
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5359
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: