Basic Information
Provider Information | |||||||||
NPI: | 1871644674 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COOKE | ||||||||
FirstName: | DOUGLAS | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPC LMFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1001 | ||||||||
Address2: |   | ||||||||
City: | GUNTERSVILLE | ||||||||
State: | AL | ||||||||
PostalCode: | 359767001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2565828880 | ||||||||
FaxNumber: | 2565828890 | ||||||||
Practice Location | |||||||||
Address1: | 1612 RAILROAD AVE | ||||||||
Address2: |   | ||||||||
City: | GUNTERSVILLE | ||||||||
State: | AL | ||||||||
PostalCode: | 359761111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2565828880 | ||||||||
FaxNumber: | 2565828890 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/16/2007 | ||||||||
LastUpdateDate: | 06/05/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 922 | AL | Y |   | Behavioral Health & Social Service Providers | Counselor |   | 101Y00000X | 77 | AL | N |   | Behavioral Health & Social Service Providers | Counselor |   |
ID Information
ID | Type | State | Issuer | Description | 51520233COO | 01 | AL | BCBS OF ALABAMA | OTHER | 51510017COO | 01 | AL | FEDERAL BCBS | OTHER |