Provider Demographics
NPI:1366131948
Name:COOK PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:COOK PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:618-203-4790
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-0791
Mailing Address - Country:US
Mailing Address - Phone:618-203-4790
Mailing Address - Fax:618-305-8449
Practice Address - Street 1:604 EASTGATE ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3304
Practice Address - Country:US
Practice Address - Phone:618-203-4790
Practice Address - Fax:618-305-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty