Provider Demographics
NPI:1194161810
Name:COOK, SAMANTHA ANN (PSYD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:HIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:445 E JEFFREY PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1824
Mailing Address - Country:US
Mailing Address - Phone:937-307-9032
Mailing Address - Fax:
Practice Address - Street 1:6641 N HIGH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4038
Practice Address - Country:US
Practice Address - Phone:614-504-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health