Provider Demographics
NPI:1407375355
Name:COOK, DANIELLE KYRSTEN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KYRSTEN
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 1:3506 LONG BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-2984
Mailing Address - Country:US
Mailing Address - Phone:406-853-3606
Mailing Address - Fax:
Practice Address - Street 1:3506 LONG BRANCH AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-2984
Practice Address - Country:US
Practice Address - Phone:406-853-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND917-9-1-17101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional