1841714268 NPI number — MRS. LORI ANN COOK LPC

Table of content: MRS. LORI ANN COOK LPC (NPI 1841714268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841714268 NPI number — MRS. LORI ANN COOK LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
LORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1841714268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENTON DRIVE, SUITE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-347-9818
Provider Business Mailing Address Fax Number:
304-347-9820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3871 ROBERT C BYRD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-929-4130
Provider Business Practice Location Address Fax Number:
304-929-4134
Provider Enumeration Date:
07/27/2017

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: 101YM0800X , with the licence number:  2070 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5200000001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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