Provider Demographics
NPI:1538866439
Name:COOK, ARLENE MANCILLA (RMHCI)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:MANCILLA
Last Name:COOK
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 SUNTREE BLVD STE 103A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7540
Mailing Address - Country:US
Mailing Address - Phone:321-757-4015
Mailing Address - Fax:
Practice Address - Street 1:3270 SUNTREE BLVD STE 103A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7540
Practice Address - Country:US
Practice Address - Phone:321-757-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health