Provider Demographics
NPI:1184899387
Name:COOK, MARYANN (MA, LCPC)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22959 S FRANCES WAY
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3102
Mailing Address - Country:US
Mailing Address - Phone:815-258-1642
Mailing Address - Fax:
Practice Address - Street 1:23157 S THOMAS DILLON DR
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-3132
Practice Address - Country:US
Practice Address - Phone:815-467-8181
Practice Address - Fax:818-828-5696
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional