Provider Demographics
NPI:1811395445
Name:COOK, CATHARINE (LPC, LLP , RD)
Entity type:Individual
Prefix:
First Name:CATHARINE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC, LLP , RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49073-9565
Mailing Address - Country:US
Mailing Address - Phone:269-352-9033
Mailing Address - Fax:
Practice Address - Street 1:309 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5176
Practice Address - Country:US
Practice Address - Phone:269-319-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI710073133V00000X
MI6401014576101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered