Provider Demographics
NPI:1245453810
Name:COOK, CHRISTINE J (CMSE, LMHP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:CMSE, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16423 MASON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2729
Mailing Address - Country:US
Mailing Address - Phone:402-681-2503
Mailing Address - Fax:
Practice Address - Street 1:14441 DUPONT CT
Practice Address - Street 2:303
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2153
Practice Address - Country:US
Practice Address - Phone:402-330-8833
Practice Address - Fax:402-330-8884
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5591041C0700X
NE1014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health