Provider Demographics
NPI:1902819170
Name:COOK, HARRIET JONES (MA)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:JONES
Last Name:COOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 S. SYCAMORE D
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-4125
Mailing Address - Country:US
Mailing Address - Phone:714-953-7570
Mailing Address - Fax:
Practice Address - Street 1:1450 N TUSTIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8642
Practice Address - Country:US
Practice Address - Phone:714-953-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA62-41577OtherUBH
CA234401OtherMHN
CAZZZ60012ZOtherBLUE SHIELD OF CALIFORNIA