Provider Demographics
NPI:1487711305
Name:COOK, CORIE SUE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CORIE
Middle Name:SUE
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 1:16 12 AVE S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-461-3720
Mailing Address - Fax:208-461-1787
Practice Address - Street 1:16 12 AVE S
Practice Address - Street 2:SUITE 103
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-461-3720
Practice Address - Fax:208-461-1787
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW267411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00010154131OtherREGENCE
IDX6886OtherBLUE CROSS BLUE SHIELD