Provider Demographics
NPI:1295715191
Name:COOK, PETER ALAN (ED D)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:COOK
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-0237
Mailing Address - Country:US
Mailing Address - Phone:828-507-5653
Mailing Address - Fax:
Practice Address - Street 1:913 UPPER PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906
Practice Address - Country:US
Practice Address - Phone:828-507-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC466103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000530Medicaid
NC2492771Medicare ID - Type UnspecifiedPSYCHOLOGIST