Provider Demographics
NPI:1588033351
Name:COOK, REBECCA JENNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JENNETTE
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 UNION AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9412
Mailing Address - Country:US
Mailing Address - Phone:660-372-1313
Mailing Address - Fax:660-372-1339
Practice Address - Street 1:1513 UNION AVE STE 2500
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9412
Practice Address - Country:US
Practice Address - Phone:660-372-1313
Practice Address - Fax:660-372-1339
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200286801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical