Provider Demographics
NPI:1194195511
Name:MCCOOK, GIDGET
Entity Type:Individual
Prefix:
First Name:GIDGET
Middle Name:
Last Name:MCCOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MORNINGSTAR DR
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-7027
Mailing Address - Country:US
Mailing Address - Phone:505-382-1479
Mailing Address - Fax:
Practice Address - Street 1:600 1ST ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2311
Practice Address - Country:US
Practice Address - Phone:505-224-9124
Practice Address - Fax:505-247-9503
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0161031101YA0400X
NMT-0176521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)