Provider Demographics
NPI:1346202900
Name:COOK, JAMES EDWARD (MS, MFT1)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:COOK
Suffix:
Gender:M
Credentials:MS, MFT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 DONNA ST
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4516
Mailing Address - Country:US
Mailing Address - Phone:415-898-5724
Mailing Address - Fax:
Practice Address - Street 1:4283 PIEDMONT AVE
Practice Address - Street 2:SUITE A-3
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4758
Practice Address - Country:US
Practice Address - Phone:510-928-5743
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health