Provider Demographics
NPI:1427749597
Name:COOKS, KRISTAL MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:MARIE
Last Name:COOKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 PARK PLACE AVE STE 110
Mailing Address - Street 2:#1024
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1617 PARK PLACE AVE STE 110
Practice Address - Street 2:#1024
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1300
Practice Address - Country:US
Practice Address - Phone:210-235-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical