Doctor Name: | CASEY COOL |
NPI Number: | 1396935904 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LMFT |
License Number: | 1752 |
Business Practice Address: | 3614 Willow Beach Trl Sw Prior Lake, MN - 553722359 |
Business Phone Number: | 7196519515 |
Business Fax Number: | |
Mailing Address: | 3614 Willow Beach Trl Sw, PRIOR LAKE |
State: | MN |
Postal Code: | 553722359 |
Phone Number: | 7196519515 |
Fax Number: | |
NPI Enumeration Date: | 07/30/2007 |
NPI Last Update Date: | 07/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1752 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |