Basic Information
| Provider Information | |||||||||
| NPI: | 1881081545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375486842 | ||||||||
| FaxNumber: | 9375488938 | ||||||||
| Practice Location | |||||||||
| Address1: | 228 N BARRON ST | ||||||||
| Address2: | |||||||||
| City: | EATON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453201704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374567694 | ||||||||
| FaxNumber: | 9374567753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 04/21/2015 | ||||||||
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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 | 101YA0400X | CDCA.141521-PRE | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.