Provider Demographics
NPI:1750852927
Name:COOK, SHEILA RENEE
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:RENEE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 W MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2520
Mailing Address - Country:US
Mailing Address - Phone:323-750-5855
Mailing Address - Fax:323-750-5885
Practice Address - Street 1:10020 S VAN NESS AVE APT 21
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4173
Practice Address - Country:US
Practice Address - Phone:323-921-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)