Provider Demographics
NPI:1184018962
Name:COOK, JOHN K (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:COOK
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E WOODLAND AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3969
Mailing Address - Country:US
Mailing Address - Phone:610-328-2700
Mailing Address - Fax:
Practice Address - Street 1:1260 E WOODLAND AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3969
Practice Address - Country:US
Practice Address - Phone:610-328-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health