Provider Demographics
NPI:1134829658
Name:COOK, ROBERT MICHAEL (LMSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:COOK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:600 S BEACON BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2178
Mailing Address - Country:US
Mailing Address - Phone:616-805-3660
Mailing Address - Fax:
Practice Address - Street 1:600 S BEACON BLVD STE A2
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2178
Practice Address - Country:US
Practice Address - Phone:616-805-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010851721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical