Provider Demographics
NPI:1821194580
Name:COOK, STEPHEN BLAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BLAINE
Last Name:COOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:347 CLARKSON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5153
Mailing Address - Country:US
Mailing Address - Phone:307-789-6620
Mailing Address - Fax:307-789-6009
Practice Address - Street 1:190 OVERTHRUST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930
Practice Address - Country:US
Practice Address - Phone:307-789-4224
Practice Address - Fax:307-789-4225
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical