Provider Demographics
NPI:1790597789
Name:COOK, MAKENZIE JEWEL (P-LPC)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:JEWEL
Last Name:COOK
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6584 LOVE RD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8831
Mailing Address - Country:US
Mailing Address - Phone:901-870-2223
Mailing Address - Fax:
Practice Address - Street 1:1630 GOODMAN RD E STE 5
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9556
Practice Address - Country:US
Practice Address - Phone:901-647-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1293101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health