MEDICARE: ALYSSA COOKE

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	103K00000X	Behavior Analyst	BEH001479	AZ

General Provider Information

NPI Number	:	1992698740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA COOKE

Provider Business Mailing Address
First Line	:	5333 MISSION CENTER RD STE 110
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1347
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:	619-374-7134

Provider Business Practice Location Address
First Line	:	4838 E BASELINE RD STE 118
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4674
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:	619-374-7134

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

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	01/20/2026

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Directions to “ ALYSSA COOKE ” Practice Location

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