Healthcare Provider Details

I. General information

NPI: 1306462429
Provider Name (Legal Business Name): KARLA Y COTA LPC-24008
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N CENTRAL AVE STE M43
PHOENIX AZ
85004-2309
US

IV. Provider business mailing address

700 MASSACHUSETTS AVE FL 3
CAMBRIDGE MA
02139-3345
US

V. Phone/Fax

Practice location:
  • Phone: 888-500-2067
  • Fax: 617-649-8520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-24008
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: