NPIMap

Organization Active NPI

Cook Behavioral Health Clinic, PC

Doing business as Cook Behavioral Health

  • Psychologist
  • Fort Wayne, IN
National Provider Identifier
1265691257
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
20041587A Issued in IN
Legal business name
COOK BEHAVIORAL HEALTH CLINIC, PC
Doing business as
Cook Behavioral Health
Practice address
7230 Engle Rd Ste 304
Fort Wayne, IN 46804-2209
Phone
(260) 483-2400
Fax
(260) 960-9361
NPI assigned
Jun 4, 2008
Last updated
Jun 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jason T Cook, PSYDNPI 1043283641
Title
Owner
Phone
(260) 483-2400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 20041587A IN Primary

Addresses

Primary practice location

7230 Engle Rd Ste 304
Fort Wayne, IN 46804-2209

Mailing address

7230 Engle Rd Ste 304
Fort Wayne, IN 46804-2209
Phone (260) 483-2400

Other identifiers 1

IdentifierTypeStateIssuer
200290630MedicaidIN

Other names 1

  • Cook Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050204000529 IN Part B Supplier - Clinic/Group Practice 3274584487 Receives reassigned benefits from 5 practitioners
Practice locations: Fort Wayne, IN

National Provider Directory

National Provider Directory

Locations

347 W Berry St
Ste 200
Fort Wayne, IN 46802
Phone (260) 483-2400

7230 Engle Rd
Ste 304
Fort Wayne, IN 46804
Phone (260) 344-4146

909 E State Blvd
Ste F127
Fort Wayne, IN 46805
Phone (260) 483-2400

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1265691257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7230 ENGLE RD STE 304",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042209",
            "telephone_number": "260-483-2400",
            "fax_number": "260-960-9361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7230 ENGLE RD STE 304",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042209",
            "telephone_number": "260-483-2400",
            "fax_number": "260-960-9361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOK BEHAVIORAL HEALTH CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-04",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-483-2400",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041587A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200290630",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cook Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.