Provider Demographics
NPI:1184283079
Name:COOK, SHELBY R (LISW-S, LCSW-QS)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:R
Last Name:COOK
Suffix:
Gender:F
Credentials:LISW-S, LCSW-QS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CROSS POINTE ROAD
Mailing Address - Street 2:UNIT D
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-835-6068
Mailing Address - Fax:614-524-0428
Practice Address - Street 1:800 CROSS POINTE RD STE 800D
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6687
Practice Address - Country:US
Practice Address - Phone:614-835-6068
Practice Address - Fax:614-524-0428
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW223151041C0700X
OH1.2103115-SUPV1041C0700X
OH1.21031151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0353922Medicaid