Provider Demographics
NPI:1366772683
Name:COOK, LESLIE LYNNE (MA)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:LYNNE
Last Name:COOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 WILLOW GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-3201
Mailing Address - Country:US
Mailing Address - Phone:423-839-5925
Mailing Address - Fax:
Practice Address - Street 1:201 W SPRINGDALE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5158
Practice Address - Country:US
Practice Address - Phone:865-637-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health