Provider Demographics
NPI:1740584556
Name:COOK, LORI R (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:R
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W ROOSEVELT RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5086
Mailing Address - Country:US
Mailing Address - Phone:630-818-6902
Mailing Address - Fax:630-462-0069
Practice Address - Street 1:620 W ROOSEVELT RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5086
Practice Address - Country:US
Practice Address - Phone:630-818-6902
Practice Address - Fax:630-462-0069
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional