Individual
TARA COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2198 US 31 S, MANISTEE, MI 49660-9618
(231) 655-3168
Mailing address
2198 US 31 S, MANISTEE, MI 49660-9618
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
10/23/2017
Last updated
04/25/2022
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