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General NPI Number Information
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NPI Number | 1720488026
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Entity Type | Individual
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Provider Name | MELANIE MARGARET COOKE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 3101 W. 2ND CT
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City | RUSSELLVILLE
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State | AR
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Zip | 72801
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Country | US
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Telephone | 479-567-5654
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Fax | 479-567-5661
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Provider Business Mailing Address
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Address Line | PO BOX 10323
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City | RUSSELLVILLE
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State | AR
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Zip | 72812
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Country | US
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Telephone | 479-567-5654
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Fax | 479-567-5661
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7535-C
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License Number State | AR
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