Basic Information
| Provider Information | |||||||||
| NPI: | 1992204085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CDPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4627 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992200627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094565465 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 518 S BROWNE ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094565465 | ||||||||
| FaxNumber: | 5094565465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 02/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CO60653009 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.