Provider Demographics
NPI:1518570555
Name:LAUREN COOK BCBA LLC
Entity Type:Organization
Organization Name:LAUREN COOK BCBA LLC
Other - Org Name:LAUREN COOK BCBA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, BCBA
Authorized Official - Phone:707-740-3706
Mailing Address - Street 1:RISING PHOENIX BEHAVIORAL SERVICES C/O LAUREN COOK
Mailing Address - Street 2:600 F STREET SUITE 3-1007
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-740-3706
Mailing Address - Fax:
Practice Address - Street 1:2670 JACOBY CREEK RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:CA
Practice Address - Zip Code:95524-9379
Practice Address - Country:US
Practice Address - Phone:707-672-4885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty