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General NPI Number Information
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NPI Number | 1962511055
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Entity Type | Individual
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Provider Name | MARTHA FRANCES COOK LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2240 WINROW AVE USA MEDDAC, RWBAHC
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City | FORT HUACHUCA
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State | AZ
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Zip | 85613-7079
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Country | US
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Telephone | 520-538-0617
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Fax | 520-533-5715
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Provider Business Mailing Address
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Address Line | PO BOX 245
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City | SIERRA VISTA
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State | AZ
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Zip | 85636-0245
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Country | US
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Telephone | 520-538-0617
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Fax | 520-533-5715
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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 | LCSW-2541
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License Number State | AZ
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