Provider Demographics
NPI:1801865837
Name:COOK, JOAN LYNN (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 HADLEIGH HILLS CT
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-3392
Mailing Address - Country:US
Mailing Address - Phone:260-602-5373
Mailing Address - Fax:
Practice Address - Street 1:2116 HADLEIGH HILLS CT
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-3392
Practice Address - Country:US
Practice Address - Phone:260-602-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 101YM0800X
IN20042048A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200835520Medicaid
IN200835520Medicaid