Individual
MR. JERRY ALAN COOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW LADC
Contact information
Practice address
234 AVENIDA ELDORADO, SANTA FE, NM 87508-2221
(505) 466-6710
(505) 466-6710
Mailing address
234 AVENIDA ELDORADO, SANTA FE, NM 87508-2221
(505) 466-6710
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
348
OK
104100000X
Social Worker
Primary
I0879
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q6658
—
NM
Enumeration date
11/22/2006
Last updated
05/07/2026
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