Provider Demographics
NPI:1447567227
Name:COOKE, PAMELA (MFT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:COOKE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:BOISEN
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:292 ALAMO DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4243
Mailing Address - Country:US
Mailing Address - Phone:707-448-0804
Mailing Address - Fax:
Practice Address - Street 1:292 ALAMO DR
Practice Address - Street 2:SUITE 3
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4243
Practice Address - Country:US
Practice Address - Phone:707-448-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist