Provider Demographics
NPI:1003024860
Name:COOK, TERRY W (LPC, NCC, MAC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:W
Last Name:COOK
Suffix:
Gender:M
Credentials:LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CACTUS BEND CV
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5398
Mailing Address - Country:US
Mailing Address - Phone:512-863-6180
Mailing Address - Fax:
Practice Address - Street 1:100 CACTUS BEND CV
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-5398
Practice Address - Country:US
Practice Address - Phone:512-863-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0469101YP2500X
TX65790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional