MEDICARE: JONATHAN DARRELL COTTRELL JR. LPCA

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	305316	KY

General Provider Information

NPI Number	:	1184578114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DARRELL COTTRELL JR. LPCA

Provider Business Mailing Address
First Line	:	1119 BURNS RD
Second Line	:
City	:	RADCLIFF
State	:	KY
Zip	:	40160-9307
Country	:	US
Telephone Number	:	316-494-2258
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 JULIANNA CT STE 1
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-7937
Country	:	US
Telephone Number	:	270-769-3714
Fax Number	:

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

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	02/25/2026

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