Provider Demographics
NPI:1700699683
Name:COOK, MILES JOSEPH (MS)
Entity type:Individual
Prefix:MR
First Name:MILES
Middle Name:JOSEPH
Last Name:COOK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:MILES
Other - Middle Name:JOSEPH
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:289 WATERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6101
Mailing Address - Country:US
Mailing Address - Phone:916-801-4564
Mailing Address - Fax:
Practice Address - Street 1:970 CAMERADO DR STE 200
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7636
Practice Address - Country:US
Practice Address - Phone:530-677-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CAAMFT152807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional