Provider Demographics
NPI:1275081796
Name:COOK, TAMMEY (MED)
Entity Type:Individual
Prefix:
First Name:TAMMEY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 5TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-2155
Mailing Address - Country:US
Mailing Address - Phone:337-429-5129
Mailing Address - Fax:337-214-2077
Practice Address - Street 1:3501 5TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2155
Practice Address - Country:US
Practice Address - Phone:337-429-5129
Practice Address - Fax:337-214-2077
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor