Basic Information
| Provider Information | |||||||||
| NPI: | 1144667056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | NEIL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3447 HOLLOW BROOK CIR | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926261717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144259077 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 901 N PACIFIC COAST HWY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902772162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103161610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2013 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF 69151 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.