Provider Demographics
NPI:1942716071
Name:COOKE, STEPHANIE JEAN (LPC, CDCA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:COOKE
Suffix:
Gender:F
Credentials:LPC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NORTHLAND BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3600
Mailing Address - Country:US
Mailing Address - Phone:513-620-5924
Mailing Address - Fax:
Practice Address - Street 1:230 NORTHLAND BLVD STE 217
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3600
Practice Address - Country:US
Practice Address - Phone:513-620-5924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.184393101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherQMHS
OHNAMedicaid