Provider Demographics
NPI:1538322284
Name:COOK, NANCY JANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JANE
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 1:11921 MASON RD
Mailing Address - Street 2:PO BOX 594
Mailing Address - City:LICKING
Mailing Address - State:MO
Mailing Address - Zip Code:65542-9066
Mailing Address - Country:US
Mailing Address - Phone:417-217-1078
Mailing Address - Fax:573-674-4064
Practice Address - Street 1:11921 MASON RD
Practice Address - Street 2:
Practice Address - City:LICKING
Practice Address - State:MO
Practice Address - Zip Code:65542-9066
Practice Address - Country:US
Practice Address - Phone:417-217-1078
Practice Address - Fax:573-674-4064
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional