Provider Demographics
NPI:1477099844
Name:COOK, KRYSTAL E (MA)
Entity Type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 E OCEAN BLVD
Mailing Address - Street 2:APT #311
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5875
Mailing Address - Country:US
Mailing Address - Phone:951-255-8862
Mailing Address - Fax:
Practice Address - Street 1:1227 E OCEAN BLVD
Practice Address - Street 2:APT #311
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5875
Practice Address - Country:US
Practice Address - Phone:951-255-8862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician