Provider Demographics
NPI:1427105634
Name:COOK, ELIZABETH HARRIS (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HARRIS
Last Name:COOK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 SPRINGBORROW DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2171
Mailing Address - Country:US
Mailing Address - Phone:810-732-5916
Mailing Address - Fax:
Practice Address - Street 1:1224 SPRINGBORROW DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2171
Practice Address - Country:US
Practice Address - Phone:810-732-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010713001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1041C0700XMedicare ID - Type Unspecified