Basic Information
| Provider Information | |||||||||
| NPI: | 1699248583 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | KATIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 S VAUGHN WAY | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800143511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037555534 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3131 S VAUGHN WAY | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800143511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037555534 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2019 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-22-57827 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | N |
No ID Information.