1952558579 NPI number — MR. STEVEN WAYNE COOK LAC; AADC; CCGC

Table of content: MR. STEVEN WAYNE COOK LAC; AADC; CCGC (NPI 1952558579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952558579 NPI number — MR. STEVEN WAYNE COOK LAC; AADC; CCGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
STEVEN
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LAC; AADC; CCGC
Provider Gender Code:
M

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:
1952558579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 13424
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71315-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-448-0082
Provider Business Mailing Address Fax Number:
318-290-3000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 JACKSON ST. EXT.
Provider Second Line Business Practice Location Address:
SUITE 128
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-448-0082
Provider Business Practice Location Address Fax Number:
318-290-3000
Provider Enumeration Date:
08/26/2008

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: LAC#1303 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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