Provider Demographics
NPI:1235726951
Name:COOKMAN, MATTHEW (LADC, LAC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:COOKMAN
Suffix:
Gender:M
Credentials:LADC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4862
Mailing Address - Country:US
Mailing Address - Phone:701-240-1092
Mailing Address - Fax:
Practice Address - Street 1:1726 N WASHINGTON ST
Practice Address - Street 2:SUITE 60
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-795-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305109101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)