Provider Demographics
NPI:1811463938
Name:ROOK, TERRY LEE JR (LCDC III, LCADC)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:ROOK
Suffix:JR
Gender:M
Credentials:LCDC III, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 BEECHMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4304
Mailing Address - Country:US
Mailing Address - Phone:513-488-3563
Mailing Address - Fax:
Practice Address - Street 1:1717 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3330
Practice Address - Country:US
Practice Address - Phone:859-360-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021024101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)