Provider Demographics
NPI:1497304943
Name:COOK, MOLLY (LCSW-S)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11910 GREENVILLE AVE STE T511
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3596
Mailing Address - Country:US
Mailing Address - Phone:214-937-9180
Mailing Address - Fax:214-253-8017
Practice Address - Street 1:11910 GREENVILLE AVE STE T511
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3596
Practice Address - Country:US
Practice Address - Phone:214-937-9180
Practice Address - Fax:214-253-8017
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14623101YA0400X
TX64812104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX64812OtherTEXAS STATE BOARD OF SOCIAL WORK EXAMINERS
14657016OtherCAQH