Provider Demographics
NPI:1790569630
Name:COOK, KIMBERLEY (PSYD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-332 HOOLU PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5953
Mailing Address - Country:US
Mailing Address - Phone:808-291-8198
Mailing Address - Fax:
Practice Address - Street 1:91-1039 SHANGRILA ST BLDG 37
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2168
Practice Address - Country:US
Practice Address - Phone:808-291-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health