Provider Demographics
NPI:1619909116
Name:ROBERT S. COOK, PH.D., PC
Entity Type:Organization
Organization Name:ROBERT S. COOK, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SYLVESTER
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-753-0272
Mailing Address - Street 1:PO BOX 6340
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6340
Mailing Address - Country:US
Mailing Address - Phone:435-753-0272
Mailing Address - Fax:
Practice Address - Street 1:1750 RESEARCH PARK WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1955
Practice Address - Country:US
Practice Address - Phone:435-753-0272
Practice Address - Fax:435-753-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4787371-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty