Provider Demographics
NPI:1730320334
Name:COOK, NATHAN N (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:N
Last Name:COOK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-0847
Mailing Address - Country:US
Mailing Address - Phone:307-754-7970
Mailing Address - Fax:307-754-7971
Practice Address - Street 1:125 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2409
Practice Address - Country:US
Practice Address - Phone:307-754-7970
Practice Address - Fax:307-754-7971
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1477716470OtherORGANIZATION NATIONAL PROVIDER IDENTIFICATION NUMBER