Provider Demographics
NPI:1407392129
Name:KOK, CYNTHIA JOYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JOYCE
Last Name:KOK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:JOYCE
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:983 SPAULDING AVE SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-3701
Mailing Address - Country:US
Mailing Address - Phone:616-236-3326
Mailing Address - Fax:
Practice Address - Street 1:983 SPAULDING AVE SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-3701
Practice Address - Country:US
Practice Address - Phone:616-236-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011417103TC0700X
MI68010195501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical