Provider Demographics
NPI:1184799637
Name:COOK, SHARON O (LCSW, LMFT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:O
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3914
Mailing Address - Country:US
Mailing Address - Phone:817-735-8686
Mailing Address - Fax:817-735-4565
Practice Address - Street 1:6410 SOUTHWEST BLVD
Practice Address - Street 2:SUITE # 205
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3914
Practice Address - Country:US
Practice Address - Phone:817-735-8686
Practice Address - Fax:817-735-4565
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01597 &1300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032JBOtherBLUE CROSS AND BLUE SHIEL
TXR60005Medicare ID - Type Unspecified
TX00S75QMedicare ID - Type Unspecified