Provider Demographics
NPI:1568783934
Name:COOK, JULIE LOUISE (BA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LOUISE
Last Name:COOK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 N QUAPAH AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3733
Mailing Address - Country:US
Mailing Address - Phone:405-942-1056
Mailing Address - Fax:
Practice Address - Street 1:1817 N QUAPAH AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-3733
Practice Address - Country:US
Practice Address - Phone:405-942-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9000SCCMedicaid