Provider Demographics
NPI:1144922824
Name:COOK, BART DOUGLAS (MSW, SWLC, JD)
Entity type:Individual
Prefix:MR
First Name:BART
Middle Name:DOUGLAS
Last Name:COOK
Suffix:
Gender:M
Credentials:MSW, SWLC, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIMROCK WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2305
Mailing Address - Country:US
Mailing Address - Phone:970-232-4515
Mailing Address - Fax:
Practice Address - Street 1:101 RIMROCK WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-2305
Practice Address - Country:US
Practice Address - Phone:970-232-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-571301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical