Provider Demographics
NPI:1225770977
Name:CHEYENNE COOK, LLC
Entity Type:Organization
Organization Name:CHEYENNE COOK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHEYENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:SWLC
Authorized Official - Phone:406-253-3082
Mailing Address - Street 1:6969 UNCLE ROBERT LN APT 5
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3526
Mailing Address - Country:US
Mailing Address - Phone:406-253-3082
Mailing Address - Fax:
Practice Address - Street 1:313 SW HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1405
Practice Address - Country:US
Practice Address - Phone:406-253-3082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health