Doctor Name: | JASON EUGENE COOK |
NPI Number: | 1013398239 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 11141 Zealand Ave N Champlin, MN - 553163595 |
Business Phone Number: | 7639513091 |
Business Fax Number: | 7639513097 |
Mailing Address: | 11141 Zealand Ave N, CHAMPLIN |
State: | MN |
Postal Code: | 553163595 |
Phone Number: | 7639513091 |
Fax Number: | 7639513097 |
NPI Enumeration Date: | 06/12/2015 |
NPI Last Update Date: | 06/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |