Provider Demographics
NPI:1518283456
Name:COOK, LORI J (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 NICKLAUS AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5872
Mailing Address - Country:US
Mailing Address - Phone:817-938-7820
Mailing Address - Fax:817-477-3418
Practice Address - Street 1:4204 NICKLAUS AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5872
Practice Address - Country:US
Practice Address - Phone:817-938-7820
Practice Address - Fax:817-477-3418
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional