Healthcare Provider Details

I. General information

NPI: 1730090655
Provider Name (Legal Business Name): MICHELLE COOKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 POWHATTAN PKWY
TOLEDO OH
43606-3734
US

IV. Provider business mailing address

2701 POWHATTAN PKWY
TOLEDO OH
43606-3734
US

V. Phone/Fax

Practice location:
  • Phone: 419-304-8432
  • Fax:
Mailing address:
  • Phone: 419-304-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRM584773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: