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General NPI Number Information
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NPI Number | 1487089041
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Entity Type | Individual
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Provider Name | LISA COOK DRPH, LCPC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 1112 W BOUGHTON RD # 146
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1508
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Country | US
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Telephone | 312-561-4292
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 W BOUGHTON RD # 146
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1508
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Country | US
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Telephone | 312-561-4292
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 265707
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.006892
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.016410
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License Number State | IL
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