MEDICARE: COOK COUNSELING SERVICES, LLC

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	251S00000X	Community/Behavioral Health Agency	65831	TX

General Provider Information

NPI Number	:	1700106192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOK COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	4801 WOODWAY DR
Second Line	:	SUITE 300 EAST
City	:	HOUSTON
State	:	TX
Zip	:	77056-1884
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 WOODWAY DR
Second Line	:	SUITE 300 EAST
City	:	HOUSTON
State	:	TX
Zip	:	77056-1884
Country	:	US
Telephone Number	:	713-840-8227
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEREDITH COOK
Credential	:	LPC
Telephone Number	:	713-840-8227

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/08/2010

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