Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1992999643 |
---|---|
Provider Name | Lisa Michelle Cook |
First Address | La Selva Beach, CA 95076-8521 |
Second Address | La Selva Beach, CA 95076-8521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 05/09/2007 |