Provider Demographics
NPI:1356123343
Name:COOK, MIRANDA PAIGE
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:PAIGE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 EAST MAIN STREET
Mailing Address - Street 2:UNITS 3 & 4,
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:606-393-6695
Mailing Address - Fax:
Practice Address - Street 1:908 EAST MAIN STREET
Practice Address - Street 2:UNITS 3 & 4
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-4047
Practice Address - Country:US
Practice Address - Phone:606-393-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional