Provider Demographics
NPI:1033480132
Name:COOK, KEVIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 ECLIPSE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-8027
Mailing Address - Country:US
Mailing Address - Phone:435-414-5586
Mailing Address - Fax:
Practice Address - Street 1:1443 W 800 N STE 103
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2878
Practice Address - Country:US
Practice Address - Phone:801-655-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7942817-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty