Basic Information
| Provider Information | |||||||||
| NPI: | 1326093121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOKSON | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | CTRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5009 HARMONY AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028706778 | ||||||||
| FaxNumber: | 7022539625 | ||||||||
| Practice Location | |||||||||
| Address1: | 5763 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 100 A | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891461235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022530818 | ||||||||
| FaxNumber: | 7022539625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 26024 | NV | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.