Provider Demographics
NPI:1689124927
Name:COOK, LAY VERN (MSW)
Entity Type:Individual
Prefix:
First Name:LAY
Middle Name:VERN
Last Name:COOK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LAY
Other - Middle Name:VERN
Other - Last Name:SAECHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:908 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4641
Mailing Address - Country:US
Mailing Address - Phone:707-648-8121
Mailing Address - Fax:
Practice Address - Street 1:908 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4641
Practice Address - Country:US
Practice Address - Phone:707-648-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor