Provider Demographics
NPI:1871707869
Name:COOK, SUSAN L (MA, MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 EAST ROSEVILLE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7974
Mailing Address - Country:US
Mailing Address - Phone:916-789-7082
Mailing Address - Fax:916-797-8840
Practice Address - Street 1:1891 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7974
Practice Address - Country:US
Practice Address - Phone:916-789-7082
Practice Address - Fax:916-797-8840
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist