Provider Demographics
NPI:1871029355
Name:COOK, KATHRYN EMMA
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EMMA
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 EAST AVE
Mailing Address - Street 2:SUITE 124 PMB 173
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7349
Mailing Address - Country:US
Mailing Address - Phone:530-592-6322
Mailing Address - Fax:530-636-4888
Practice Address - Street 1:1074 EAST AVE
Practice Address - Street 2:SUITE A4
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1005
Practice Address - Country:US
Practice Address - Phone:530-521-8621
Practice Address - Fax:530-636-4888
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF91717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist