Basic Information
| Provider Information | |||||||||
| NPI: | 1912284274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2831 SAINT ROSE PKWY STE 222 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890524840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025894871 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2831 SAINT ROSE PKWY STE 222 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890524840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025894871 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2011 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4509 | KS | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 7700C | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.