=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194162362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUREAN RENA COOK M.ED., L.P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2013
-----------------------------------------------------
Last Update Date | 09/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E FAIR BARN RD STE B
-----------------------------------------------------
City | COALGATE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74538-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-927-2044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 39
-----------------------------------------------------
City | QUINTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74561-0039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-617-1435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------