=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427717594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARMEN COOK THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2021
-----------------------------------------------------
Last Update Date | 12/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 MAKAWAO AVE STE 205
-----------------------------------------------------
City | MAKAWAO
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96768-8859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-359-4448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 475
-----------------------------------------------------
City | MAKAWAO
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96768-0475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-359-4448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST AND OWNER
-----------------------------------------------------
Name | CARMEN AMANDA COOK
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 808-359-4448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------