Provider Demographics
NPI:1841430980
Name:COOK, JENNIFER CHRISTINE (MC, LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:COOK
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:WASHINGTON, KEYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5550 E DEER VALLEY DR APT B2-259
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5677
Mailing Address - Country:US
Mailing Address - Phone:602-228-5132
Mailing Address - Fax:
Practice Address - Street 1:5550 E DEER VALLEY DR APT B2-259
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5677
Practice Address - Country:US
Practice Address - Phone:602-228-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 2454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional