Provider Demographics
NPI:1396818704
Name:COOK, RICHARD ALLEN (PSYD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:COOK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 EAST ARAPAHOE ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-741-1077
Mailing Address - Fax:303-741-1078
Practice Address - Street 1:7400 EAST ARAPAHOE ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-741-1077
Practice Address - Fax:303-741-1078
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1268103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07012685Medicaid
COCA1516Medicare PIN
CO07012685Medicaid