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General NPI Number Information
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NPI Number | 1538603667
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Entity Type | Organization
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Legal Business Name | COOK BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 123 MCCLURE AVENUE
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City | NAMPA
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State | ID
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Zip | 83701
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Country | US
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Telephone | 208-461-3720
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 2775
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City | BOISE
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State | ID
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Zip | 83701
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Country | US
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Telephone | 208-461-3720
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Fax |
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Authorized Official
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Title or Position | CLINICAL ADMINISTRATOR
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Name | MRS. CORIE SUE COOK
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Credential | LCSW, ACSW
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Telephone | 208-461-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW-29576
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License Number State | ID
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