Provider Demographics
NPI:1427717594
Name:CARMEN COOK THERAPY, INC.
Entity type:Organization
Organization Name:CARMEN COOK THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-359-4448
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0475
Mailing Address - Country:US
Mailing Address - Phone:808-359-4448
Mailing Address - Fax:
Practice Address - Street 1:81 MAKAWAO AVE STE 205
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8859
Practice Address - Country:US
Practice Address - Phone:808-359-4448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty