Healthcare Provider Details

I. General information

NPI: 1609407261
Provider Name (Legal Business Name): MARISSA COOK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA FARLOW

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 03/10/2025
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W 1ST AVE
SPOKANE WA
99201
US

IV. Provider business mailing address

1209 W 1ST AVE
SPOKANE WA
99201
US

V. Phone/Fax

Practice location:
  • Phone: 509-995-3388
  • Fax: 509-321-4350
Mailing address:
  • Phone: 509-995-3388
  • Fax: 509-321-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79137
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61511498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: