Provider Demographics
NPI:1023527454
Name:SUSAN KEORTGE COOK, PH.D.
Entity type:Organization
Organization Name:SUSAN KEORTGE COOK, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KEORTGE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-205-8491
Mailing Address - Street 1:2801 YOUNGFIELD ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401
Mailing Address - Country:US
Mailing Address - Phone:303-205-8491
Mailing Address - Fax:303-232-0384
Practice Address - Street 1:2801 YOUNGFIELD ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401
Practice Address - Country:US
Practice Address - Phone:303-205-8491
Practice Address - Fax:303-232-0384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUSAN KEORTGE COOK, PH.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2696103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty