Provider Demographics
NPI:1790726354
Name:COOK, WILLIAM A (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:COOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W GRANITE ST
Mailing Address - Street 2:SUITE #206
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9215
Mailing Address - Country:US
Mailing Address - Phone:406-782-2265
Mailing Address - Fax:406-563-5794
Practice Address - Street 1:125 W GRANITE ST
Practice Address - Street 2:SUITE #206
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9215
Practice Address - Country:US
Practice Address - Phone:406-782-2265
Practice Address - Fax:406-563-5794
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT309103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT490280Medicaid
MT050027Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER