Provider Demographics
NPI:1740031640
Name:COOK, EMILEE MARIE (LBA)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NW 167TH PL STE 320
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4806
Mailing Address - Country:US
Mailing Address - Phone:503-836-7590
Mailing Address - Fax:
Practice Address - Street 1:1600 NW 167TH PL STE 320
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4806
Practice Address - Country:US
Practice Address - Phone:503-836-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10260057103K00000X
VA0133003521103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst