Healthcare Provider Details

I. General information

NPI: 1790726354
Provider Name (Legal Business Name): WILLIAM A. COOK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W GRANITE ST SUITE #206
BUTTE MT
59701-9215
US

IV. Provider business mailing address

125 W GRANITE ST SUITE #206
BUTTE MT
59701-9215
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-2265
  • Fax: 406-563-5794
Mailing address:
  • Phone: 406-782-2265
  • Fax: 406-563-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number309
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: