Provider Demographics
NPI:1750742441
Name:COOKSEY, NATHAN (LPC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:COOKSEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W BETHEL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4473
Mailing Address - Country:US
Mailing Address - Phone:972-393-1596
Mailing Address - Fax:
Practice Address - Street 1:413 W BETHEL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4473
Practice Address - Country:US
Practice Address - Phone:972-393-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional