MEDICARE: JAMES EDWARD COOK M.S., M.F.T.1

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
1	101YM0800X	Mental Health Counselor	MFC30796	CA

General Provider Information

NPI Number	:	1346202900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD COOK M.S., M.F.T.1

Provider Business Mailing Address
First Line	:	1385 DONNA ST
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94947-4516
Country	:	US
Telephone Number	:	415-898-5724
Fax Number	:

Provider Business Practice Location Address
First Line	:	4283 PIEDMONT AVE
Second Line	:	SUITE A-3
City	:	OAKLAND
State	:	CA
Zip	:	94611-4758
Country	:	US
Telephone Number	:	510-928-5743
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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