Provider Demographics
NPI:1871882340
Name:COOK, KATHRYN JUNE (LMSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JUNE
Last Name:COOK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JUNE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:2550 S TELEGRAPH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0909
Mailing Address - Country:US
Mailing Address - Phone:248-322-0003
Mailing Address - Fax:248-322-0006
Practice Address - Street 1:2550 S TELEGRAPH RD STE 250
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-322-0003
Practice Address - Fax:248-322-0006
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088653104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker