Provider Demographics
NPI:1518698687
Name:COOK, ALLISON RENEE (LAC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
Last Name:COOK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8869 HIGHWAY 79 S
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-8827
Mailing Address - Country:US
Mailing Address - Phone:870-534-1021
Mailing Address - Fax:
Practice Address - Street 1:8869 HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-8827
Practice Address - Country:US
Practice Address - Phone:870-534-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2102207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health