Provider Demographics
NPI:1023489564
Name:COOK, CHARLOTTE
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
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 1:3356 E SOUTHERN HILLS BLVD
Mailing Address - Street 2:#4
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2842
Mailing Address - Country:US
Mailing Address - Phone:417-818-1434
Mailing Address - Fax:
Practice Address - Street 1:2200 E SUNSHINE ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1924
Practice Address - Country:US
Practice Address - Phone:417-551-2435
Practice Address - Fax:417-719-7973
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150002581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical