Provider Demographics
NPI:1528406360
Name:MONIQUE COOK
Entity Type:Organization
Organization Name:MONIQUE COOK
Other - Org Name:MONIQUE COOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BASIC SKILLS TRAINER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-894-8434
Mailing Address - Street 1:7039 E MESQUITE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4234
Mailing Address - Country:US
Mailing Address - Phone:909-894-8434
Mailing Address - Fax:
Practice Address - Street 1:7039 E MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-4234
Practice Address - Country:US
Practice Address - Phone:909-894-8434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty