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General NPI Number Information
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NPI Number | 1710702907
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Entity Type | Organization
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Legal Business Name | COOK CHILDREN'S MEDICAL CENTER
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1500 COOPER ST
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City | FORT WORTH
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State | TX
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Zip | 76104-2710
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Country | US
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Telephone | 682-885-1480
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Fax | 682-885-3600
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Provider Business Mailing Address
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Address Line | PO BOX 99213
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City | FORT WORTH
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State | TX
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Zip | 76199-0213
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Country | US
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Telephone | 682-885-1860
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Fax | 682-885-1396
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICIER
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Name | CORY R RHOADES
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Credential |
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Telephone | 682-885-4480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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