Provider Demographics
NPI:1699862672
Name:COOK, J. WILLIAM (PHD)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:WILLIAM
Last Name:COOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:T-214 FORT MISSOULA
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7209
Mailing Address - Country:US
Mailing Address - Phone:406-396-8472
Mailing Address - Fax:406-542-0143
Practice Address - Street 1:T-214 FORT MISSOULA
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7209
Practice Address - Country:US
Practice Address - Phone:406-396-8472
Practice Address - Fax:406-542-0143
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT84103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical