Provider Demographics
NPI:1457594426
Name:COOK, MICHELLE (LPC-S,RPT-S)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC-S,RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LAUREL TRL
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6608
Mailing Address - Country:US
Mailing Address - Phone:830-214-0988
Mailing Address - Fax:830-214-0988
Practice Address - Street 1:308 E SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4538
Practice Address - Country:US
Practice Address - Phone:830-660-8515
Practice Address - Fax:830-214-0988
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17072101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1486565-01Medicaid