MEDICARE: AMANDA COTHERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134417199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA COTHERN

Provider Business Mailing Address
First Line	:	1437 E 38TH PL
Second Line	:	APT A
City	:	TULSA
State	:	OK
Zip	:	74105-3359
Country	:	US
Telephone Number	:	918-855-9853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 E 38TH PL
Second Line	:	APT A
City	:	TULSA
State	:	OK
Zip	:	74105-3359
Country	:	US
Telephone Number	:	918-855-9853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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Directions to “ AMANDA COTHERN ” Practice Location

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