Basic Information
| Provider Information | |||||||||
| NPI: | 1255869061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | |||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2972 N KREPPS RD | ||||||||
| Address2: | |||||||||
| City: | SAINT JOHNS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488799089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893079470 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 913 W HOLMES RD | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489100426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893079470 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2017 | ||||||||
| LastUpdateDate: | 05/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401015972 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.