Provider Demographics
NPI:1710146477
Name:COOKSON, GLENN ALLEN
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ALLEN
Last Name:COOKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81880 DOCTOR CARREON BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5559
Mailing Address - Country:US
Mailing Address - Phone:951-663-4842
Mailing Address - Fax:
Practice Address - Street 1:81880 DOCTOR CARREON BLVD
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5559
Practice Address - Country:US
Practice Address - Phone:951-663-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health