Healthcare Provider Details

I. General information

NPI: 1467236497
Provider Name (Legal Business Name): MICHAEL DEAN COOKSIE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W 10600 S STE 1700
SANDY UT
84070-4144
US

IV. Provider business mailing address

CMR 411 BOX 6604
APO AE
09112-0067
US

V. Phone/Fax

Practice location:
  • Phone: 845-329-0438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12371389-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: