Provider Demographics
NPI:1376539031
Name:COOK, MARGARET A
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:A
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-1624
Mailing Address - Country:US
Mailing Address - Phone:269-273-5000
Mailing Address - Fax:269-273-8019
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-1624
Practice Address - Country:US
Practice Address - Phone:269-273-5000
Practice Address - Fax:269-273-8019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005966101YM0800X
IN39000300A101YM0800X
MI6301009257103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1708146Medicaid
MI1708146Medicaid