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General NPI Number Information
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NPI Number | 1750122479
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Entity Type | Individual
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Provider Name | AMY COOK LCMHC
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 564 ROUTE 2 STE 5
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City | SOUTH HERO
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State | VT
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Zip | 05486-4308
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Country | US
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Telephone | 802-559-2575
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Fax |
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Provider Business Mailing Address
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Address Line | 8 ACCESS RD
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City | MILTON
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State | VT
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Zip | 05468-3300
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Country | US
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Telephone | 802-893-3878
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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 | 068.0135926
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License Number State | VT
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