Basic Information
| Provider Information | |||||||||
| NPI: | 1164055844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 W 40TH ST UNIT 2225 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374091379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234860774 | ||||||||
| FaxNumber: | 4234056346 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 S SEMINOLE DR | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374121135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234860774 | ||||||||
| FaxNumber: | 4234056346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2020 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP1600X | Y | Behavioral Health & Social Service Providers | Counselor | Pastoral |
No ID Information.