Provider Demographics
NPI:1023001435
Name:COOK, LINDA JOYCE (PHD LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JOYCE
Last Name:COOK
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13433 SE SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754
Mailing Address - Country:US
Mailing Address - Phone:541-350-0117
Mailing Address - Fax:866-740-0637
Practice Address - Street 1:13433 SE SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754
Practice Address - Country:US
Practice Address - Phone:541-350-0117
Practice Address - Fax:866-740-0637
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL33811041C0700X, 101YM0800X
WALW000075481041C0700X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275397Medicaid
74242700OtherMAGELLAN
332339OtherMANAGED HEALTH NETWORK
ORJ874101OtherPACIFIC SOURCE
OR838283000OtherBLUE CROSS
OR118885Medicare ID - Type Unspecified