Provider Demographics
NPI:1679831127
Name:COOK, KELLI (LPC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WILLIAM D TATE AVE STE 800A
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8755
Mailing Address - Country:US
Mailing Address - Phone:817-488-8998
Mailing Address - Fax:855-295-2686
Practice Address - Street 1:2415 COIT RD
Practice Address - Street 2:SUITE B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3758
Practice Address - Country:US
Practice Address - Phone:972-596-7229
Practice Address - Fax:972-596-7410
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional