Provider Demographics
NPI:1194296053
Name:COOK, SHIRITA YULANDA
Entity type:Individual
Prefix:
First Name:SHIRITA
Middle Name:YULANDA
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6342 CENTURY CITY S APT 6
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2745
Mailing Address - Country:US
Mailing Address - Phone:614-795-5069
Mailing Address - Fax:
Practice Address - Street 1:85 E GAY ST STE 800
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3118
Practice Address - Country:US
Practice Address - Phone:614-551-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional