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General NPI Number Information
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NPI Number | 1023527454
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Entity Type | Organization
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Legal Business Name | SUSAN KEORTGE COOK, PH.D.
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 09/28/2017
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Provider Practice Location Address
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Address Line | 2801 YOUNGFIELD ST. SUITE 300
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City | GOLDEN
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State | CO
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Zip | 80401
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Country | US
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Telephone | 303-205-8491
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Fax | 303-232-0384
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Provider Business Mailing Address
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Address Line | 2801 YOUNGFIELD ST. SUITE 300
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City | GOLDEN
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State | CO
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Zip | 80401
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Country | US
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Telephone | 303-205-8491
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Fax | 303-232-0384
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. SUSAN KEORTGE COOK
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Credential | PH.D.
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Telephone | 303-205-8491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2696
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License Number State | CO
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