Provider Demographics
NPI:1013012129
Name:COOK, DIANA LYN (PHD, CDP, MFT)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYN
Last Name:COOK
Suffix:
Gender:F
Credentials:PHD, CDP, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21701 76TH AVE W
Mailing Address - Street 2:SUITE #306
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7536
Mailing Address - Country:US
Mailing Address - Phone:425-744-1750
Mailing Address - Fax:425-744-1751
Practice Address - Street 1:21701 76TH AVE W
Practice Address - Street 2:SUITE #306
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7536
Practice Address - Country:US
Practice Address - Phone:425-744-1750
Practice Address - Fax:425-744-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical