Joseph Cook Jr.
Individual provider Active NPI Counselor · Cass Lake, MN
NPI 1194154542 · NPPES record last updated Nov 6, 2013
Key facts
- NPI
- 1194154542
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 201204 (MN)
- Practice address
- 115 6TH St NW
Cass Lake, MN 56633-3428 - Phone
- (218) 335-3050
- NPI assigned
- Nov 6, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201204 | MN | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 201204 | MN | Yes |
Addresses
Primary practice location
115 6TH St NW
Cass Lake, MN 56633-3428
Mailing address
115 6TH St NW
Cass Lake, MN 56633-3428
Other providers in Cass Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.