Provider Demographics
NPI:1639348790
Name:COOK, JOAN P (MC, LMFT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:P
Last Name:COOK
Suffix:
Gender:F
Credentials:MC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 W WETHERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-8123
Mailing Address - Country:US
Mailing Address - Phone:602-548-8508
Mailing Address - Fax:
Practice Address - Street 1:17505 N 79TH AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8725
Practice Address - Country:US
Practice Address - Phone:602-548-8508
Practice Address - Fax:623-879-5146
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT0323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist