Provider Demographics
NPI:1841277894
Name:COOK, MARK ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:COOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:172 CLARKSON EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2114
Mailing Address - Country:US
Mailing Address - Phone:636-230-3113
Mailing Address - Fax:636-230-3044
Practice Address - Street 1:172 CLARKSON EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2114
Practice Address - Country:US
Practice Address - Phone:636-230-3113
Practice Address - Fax:636-230-3044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5018OtherBLUE CROSS BLUE SHIELD MO
431466627C00OtherMERCY UNITY HEALTH PLAN
115397OtherHEALTHLINK PPO