Provider Demographics
NPI:1073963377
Name:COOK, ROGER (LMFT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4517
Mailing Address - Country:US
Mailing Address - Phone:408-622-9411
Mailing Address - Fax:
Practice Address - Street 1:4 QUAIL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4517
Practice Address - Country:US
Practice Address - Phone:408-622-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist