Provider Demographics
NPI:1477657054
Name:COOKS-ALLEN, TWANA LEE (PHD LCSW LMFT)
Entity Type:Individual
Prefix:DR
First Name:TWANA
Middle Name:LEE
Last Name:COOKS-ALLEN
Suffix:
Gender:F
Credentials:PHD LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1806
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-6806
Mailing Address - Country:US
Mailing Address - Phone:314-995-1235
Mailing Address - Fax:
Practice Address - Street 1:2236 WARREN ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-2441
Practice Address - Country:US
Practice Address - Phone:314-995-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003128104100000X
NY000476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496804600Medicaid
000078750Medicare UPIN
MO496804600Medicaid