Provider Demographics
NPI:1457410243
Name:COOK, JENNIFER LYNN (LMHP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N WEBB RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1751
Mailing Address - Country:US
Mailing Address - Phone:308-381-5877
Mailing Address - Fax:308-381-5879
Practice Address - Street 1:2121 N WEBB RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1751
Practice Address - Country:US
Practice Address - Phone:308-381-5877
Practice Address - Fax:308-381-5879
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024978000Medicaid
NE85411OtherBLUE CROS BLUE SHIELD