=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093293193
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARTHUR LYNN COOK LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2018
-----------------------------------------------------
Last Update Date | 07/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 NW 4TH ST
-----------------------------------------------------
City | BRYANT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72022-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-847-5660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 WATERSIDE DR
-----------------------------------------------------
City | MAUMELLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72113-5838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-529-9138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | M0611010
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------