Organization
PLATINUM BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MALCOLM COOK NP (NURSE PRACTITIONER)
(240) 353-1018
Entity
Organization
Contact information
Practice address
1125 WEST ST STE 235, ANNAPOLIS, MD 21401-4198
(240) 353-1018
Mailing address
2019 S ANVIL LN, TEMPLE HILLS, MD 20748-4286
(240) 353-1018
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15880647208
—
MD
Enumeration date
01/24/2020
Last updated
10/26/2020
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