Provider Demographics
NPI:1922467968
Name:COOK, JONATHAN (MAT, MS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:MAT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 28TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1088
Mailing Address - Country:US
Mailing Address - Phone:205-920-1945
Mailing Address - Fax:205-752-0590
Practice Address - Street 1:420 28TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1088
Practice Address - Country:US
Practice Address - Phone:205-920-1945
Practice Address - Fax:205-752-0590
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist