Provider Demographics
NPI:1255852836
Name:COOK, MALTON JR (LPC)
Entity type:Individual
Prefix:MR
First Name:MALTON
Middle Name:
Last Name:COOK
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N STEMMONS FWY STE 3052
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3969
Mailing Address - Country:US
Mailing Address - Phone:469-223-9660
Mailing Address - Fax:
Practice Address - Street 1:1701 GATEWAY BLVD STE 385
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3546
Practice Address - Country:US
Practice Address - Phone:469-223-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74945101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health