Provider Demographics
NPI:1790652352
Name:COOK, SHAWNA MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3771
Mailing Address - Country:US
Mailing Address - Phone:712-213-2205
Mailing Address - Fax:319-358-4198
Practice Address - Street 1:1401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3771
Practice Address - Country:US
Practice Address - Phone:712-213-2205
Practice Address - Fax:319-358-4198
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional