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NPI Code Detail

MEDICARE: MRS. JESSICA ANN COOK LPC

MEDICARE: MRS. JESSICA ANN COOK LPC
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
1101YP2500XProfessional Counselor0701005216VA

General Provider Information

NPI Number : 1417292665
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA ANN COOK LPC
Provider Business Mailing Address
First Line : 3433 BRAMBLETON AVE STE 201A
Second Line :
City : ROANOKE
State : VA
Zip : 24018-6527
Country : US
Telephone Number : 540-589-1127
Fax Number :
Provider Business Practice Location Address
First Line : 3433 BRAMBLETON AVE STE 201A
Second Line :
City : ROANOKE
State : VA
Zip : 24018-6527
Country : US
Telephone Number : 540-589-1127
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2012
Last Update Date : 11/28/2012

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Directions to “ MRS. JESSICA ANN COOK LPC” Practice Location

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