Provider Demographics
NPI:1679073563
Name:COLLEEN M. COOK, PH.D., PLLC
Entity Type:Organization
Organization Name:COLLEEN M. COOK, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-323-0813
Mailing Address - Street 1:40 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4351
Mailing Address - Country:US
Mailing Address - Phone:614-323-0813
Mailing Address - Fax:
Practice Address - Street 1:1 GREENLEAF WOODS DR UNIT 302
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5437
Practice Address - Country:US
Practice Address - Phone:614-323-0813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH809261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11658090OtherCAQH