Provider Demographics
NPI:1194162362
Name:COOK, JUREAN RENA (MED, LPC)
Entity type:Individual
Prefix:
First Name:JUREAN
Middle Name:RENA
Last Name:COOK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:OK
Mailing Address - Zip Code:74561-0039
Mailing Address - Country:US
Mailing Address - Phone:918-617-1435
Mailing Address - Fax:
Practice Address - Street 1:101 E FAIR BARN RD STE B
Practice Address - Street 2:
Practice Address - City:COALGATE
Practice Address - State:OK
Practice Address - Zip Code:74538-2627
Practice Address - Country:US
Practice Address - Phone:580-927-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)