Healthcare Provider Details

I. General information

NPI: 1417328691
Provider Name (Legal Business Name): TESSA NICOLE COOKE CN, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 112TH AVE SE STE. 100 #35
BELLEVUE WA
98004-6901
US

IV. Provider business mailing address

PO BOX 4221
BELLEVUE WA
98009-4221
US

V. Phone/Fax

Practice location:
  • Phone: 425-591-7027
  • Fax:
Mailing address:
  • Phone: 425-591-7027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60311548
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU60311487
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: