Healthcare Provider Details

I. General information

NPI: 1356128359
Provider Name (Legal Business Name): BRIANNA PAUL COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 NE MAPLE AVE
REDMOND OR
97756-8527
US

IV. Provider business mailing address

PO BOX 1710
REDMOND OR
97756-0516
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-9577
  • Fax:
Mailing address:
  • Phone: 541-516-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-23-2791
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: