Provider Demographics
NPI:1215248505
Name:COOK, JILL KATHERINE (LMFT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:KATHERINE
Last Name:COOK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 PLEASANTVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-6204
Mailing Address - Country:US
Mailing Address - Phone:541-441-3707
Mailing Address - Fax:
Practice Address - Street 1:1590 SE N ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-4026
Practice Address - Country:US
Practice Address - Phone:541-441-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist