Provider Demographics
NPI:1033463070
Name:COOK, ERIN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 E EMILE ZOLA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6248
Mailing Address - Country:US
Mailing Address - Phone:805-448-5447
Mailing Address - Fax:
Practice Address - Street 1:5025 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7437
Practice Address - Country:US
Practice Address - Phone:602-680-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12478103K00000X
AZBA-109103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst