Provider Demographics
NPI:1720488026
Name:COOKE, MELANIE MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARGARET
Last Name:COOKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10323
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72812
Mailing Address - Country:US
Mailing Address - Phone:479-567-5654
Mailing Address - Fax:479-567-5661
Practice Address - Street 1:3101 W. 2ND CT
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801
Practice Address - Country:US
Practice Address - Phone:479-567-5654
Practice Address - Fax:479-567-5661
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7535-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR227119719Medicaid