Provider Demographics
NPI:1730491531
Name:COOK, LILY A (LPC, CADC I)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:A
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 SE 11TH AVE
Mailing Address - Street 2:STE 232
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1062
Mailing Address - Country:US
Mailing Address - Phone:503-285-0013
Mailing Address - Fax:855-820-1151
Practice Address - Street 1:2505 SE 11TH AVE
Practice Address - Street 2:STE 232
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1062
Practice Address - Country:US
Practice Address - Phone:503-285-0013
Practice Address - Fax:855-820-1151
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2671101YA0400X, 101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional