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NPI Code Detail

MEDICARE: DEBORAH COOKS I

MEDICARE: DEBORAH COOKS I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1235514829
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH COOKS I
Provider Business Mailing Address
First Line : 106 MARIGOLD LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2326
Country : US
Telephone Number : 702-203-2440
Fax Number :
Provider Business Practice Location Address
First Line : 1735 N NELLIS BLVD STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-3670
Country : US
Telephone Number : 702-459-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2015
Last Update Date : 07/23/2015

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Directions to “ DEBORAH COOKS I ” Practice Location

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