Provider Demographics
NPI:1629357785
Name:COOK, RALPH DOUGLAS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:DOUGLAS
Last Name:COOK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 CORINTH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7603
Mailing Address - Country:US
Mailing Address - Phone:615-504-8362
Mailing Address - Fax:615-220-0054
Practice Address - Street 1:6201 CORINTH RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7603
Practice Address - Country:US
Practice Address - Phone:615-504-8362
Practice Address - Fax:615-220-0054
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist