Provider Demographics
NPI:1023203379
Name:COOK, CHARLES JACK JR (MBA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JACK
Last Name:COOK
Suffix:JR
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15095 AMARGOSA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1879
Mailing Address - Country:US
Mailing Address - Phone:760-780-4016
Mailing Address - Fax:760-780-4005
Practice Address - Street 1:15095 AMARGOSA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1879
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:760-245-5896
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2010-12-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor