Provider Demographics
NPI:1700084290
Name:COOK & TAFOYA-FISHER BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:COOK & TAFOYA-FISHER BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-461-3720
Mailing Address - Street 1:16 12TH AVE S SUITE 103
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651
Mailing Address - Country:US
Mailing Address - Phone:208-461-3720
Mailing Address - Fax:208-461-1787
Practice Address - Street 1:16 12TH AVE S STE 103
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3962
Practice Address - Country:US
Practice Address - Phone:208-461-3720
Practice Address - Fax:208-461-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW562251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health