Provider Demographics
NPI:1417757618
Name:COOK, REBECCA JUANEICE (RADT)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JUANEICE
Last Name:COOK
Suffix:
Gender:
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25967 YALE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4877
Mailing Address - Country:US
Mailing Address - Phone:951-665-0259
Mailing Address - Fax:
Practice Address - Street 1:2220 GIRARD ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5301
Practice Address - Country:US
Practice Address - Phone:951-925-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1601070225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)