Provider Demographics
NPI:1902437510
Name:COOKE, PHILIP JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JAMES
Last Name:COOKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 N GLENWOOD AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1365
Mailing Address - Country:US
Mailing Address - Phone:301-661-1166
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1506
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1849
Practice Address - Country:US
Practice Address - Phone:773-769-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010233103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling