Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | L3381 | OR |
Y | 103TC1900X | Counseling Psychologist | ||
N | 1041C0700X | Clinical Social Worker | L3381 | OR |
N | 1041C0700X | Clinical Social Worker | LW00007548 | WA |
NPI | 1023001435 |
---|---|
Provider Name | Mrs. Linda Joyce Cook |
First Address | Prineville, OR 97754 |
Second Address | Prineville, OR 97754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 06/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275397 | (05) | OR |
332339 | MANAGED HEALTH NETWORK (01) | |
74242700 | MAGELLAN (01) | |
838283000 | BLUE CROSS (01) | OR |
J874101 | PACIFIC SOURCE (01) | OR |