Provider Demographics
NPI:1851430375
Name:COOK, JILL C (MS, LADC, LMHP)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:C
Last Name:COOK
Suffix:
Gender:F
Credentials:MS, LADC, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 W 39TH ST
Mailing Address - Street 2:102
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845
Mailing Address - Country:US
Mailing Address - Phone:308-338-0823
Mailing Address - Fax:308-338-0823
Practice Address - Street 1:2315 W 39TH ST
Practice Address - Street 2:102
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845
Practice Address - Country:US
Practice Address - Phone:308-338-0823
Practice Address - Fax:308-338-0823
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE457101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)