Provider Demographics
NPI:1093356008
Name:COOK, JONATHON ROBERT (CDP-T)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:ROBERT
Last Name:COOK
Suffix:
Gender:M
Credentials:CDP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 BOSTON HARBOR RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-1843
Mailing Address - Country:US
Mailing Address - Phone:360-489-5778
Mailing Address - Fax:
Practice Address - Street 1:3773 MARTIN WAY E STE 105
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4400
Practice Address - Country:US
Practice Address - Phone:360-688-7318
Practice Address - Fax:360-688-7312
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60960767101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)