Provider Demographics
NPI:1275060519
Name:COOK, MICHAEL TROY (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TROY
Last Name:COOK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5540
Mailing Address - Country:US
Mailing Address - Phone:337-400-4443
Mailing Address - Fax:
Practice Address - Street 1:2829 4TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7887
Practice Address - Country:US
Practice Address - Phone:337-508-2300
Practice Address - Fax:337-508-2291
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2021-01-19
Deactivation Date:2018-03-19
Deactivation Code:
Reactivation Date:2019-01-16
Provider Licenses
StateLicense IDTaxonomies
LA7677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health