Provider Demographics
NPI:1629578711
Name:COOK, CAITLYN ELIZABETH (PCSS)
Entity Type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:ELIZABETH
Last Name:COOK
Suffix:
Gender:F
Credentials:PCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 MARIA LN
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-1139
Mailing Address - Country:US
Mailing Address - Phone:662-423-3332
Mailing Address - Fax:662-423-3331
Practice Address - Street 1:1223 MARIA LN
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1139
Practice Address - Country:US
Practice Address - Phone:662-423-3332
Practice Address - Fax:662-423-3331
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018204Medicaid