Basic Information
| Provider Information | |||||||||
| NPI: | 1023232717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOKE | ||||||||
| FirstName: | DARREN | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1630 E SHAW AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937108109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592488550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1235 E ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937062024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592686261 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | PRELICENSED#IMF50522 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | IMF70529 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YA0400X | R124030916 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.