1720488026 NPI number — MELANIE MARGARET COOKE LCSW

Table of content: MELANIE MARGARET COOKE LCSW (NPI 1720488026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720488026 NPI number — MELANIE MARGARET COOKE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOKE
Provider First Name:
MELANIE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720488026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10323
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-567-5654
Provider Business Mailing Address Fax Number:
479-567-5661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 W. 2ND CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-567-5654
Provider Business Practice Location Address Fax Number:
479-567-5661
Provider Enumeration Date:
08/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  7535-C , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 227119719 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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