Provider Demographics
NPI:1831249820
Name:COOK, DAVID PAUL (MS, MDIV)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:COOK
Suffix:
Gender:M
Credentials:MS, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DAKOTA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3742
Mailing Address - Country:US
Mailing Address - Phone:815-356-9683
Mailing Address - Fax:815-356-8975
Practice Address - Street 1:600 DAKOTA ST
Practice Address - Street 2:SUITE B
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3742
Practice Address - Country:US
Practice Address - Phone:815-356-9683
Practice Address - Fax:815-356-8975
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166-000196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist