Healthcare Provider Details

I. General information

NPI: 1134054851
Provider Name (Legal Business Name): ELISSE COOK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 S COMMERCE DR
MURRAY UT
84107-4761
US

IV. Provider business mailing address

762 W SUNNY RIVER RD APT 1523
TAYLORSVILLE UT
84123-2876
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-2813
  • Fax:
Mailing address:
  • Phone: 248-515-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7581710
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13623614-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: