Provider Demographics
NPI:1962659425
Name:COOK, SARA (BA)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19871 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3982
Mailing Address - Country:US
Mailing Address - Phone:313-622-4167
Mailing Address - Fax:313-893-0064
Practice Address - Street 1:19871 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3982
Practice Address - Country:US
Practice Address - Phone:313-622-4167
Practice Address - Fax:313-893-0064
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid