MEDICARE: WILLIS COOKS

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	1041C0700X	Clinical Social Worker	48711	CA

General Provider Information

NPI Number	:	1972151868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIS COOKS

Provider Business Mailing Address
First Line	:	812 E HYDE PARK BLVD APT 7
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-1792
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8929 S SEPULVEDA BLVD STE 410
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3634
Country	:	US
Telephone Number	:	424-317-6800
Fax Number	:

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

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	09/03/2019

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Directions to “ WILLIS COOKS ” Practice Location

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