Provider Demographics
NPI:1518395664
Name:KATIE COOK
Entity Type:Organization
Organization Name:KATIE COOK
Other - Org Name:BCBA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:949-923-5323
Mailing Address - Street 1:1301 HOLLENCREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3712
Mailing Address - Country:US
Mailing Address - Phone:949-923-5323
Mailing Address - Fax:
Practice Address - Street 1:1301 HOLLENCREST DR
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-3712
Practice Address - Country:US
Practice Address - Phone:949-923-5323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-10219251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health