Provider Demographics
NPI:1740409507
Name:COOK, TERRY E (LPCC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6494 SHIPSLANDING AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4211
Mailing Address - Country:US
Mailing Address - Phone:330-744-3320
Mailing Address - Fax:330-744-3677
Practice Address - Street 1:3112 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2813
Practice Address - Country:US
Practice Address - Phone:330-491-0896
Practice Address - Fax:330-491-1298
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0007925101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor