Healthcare Provider Details

I. General information

NPI: 1134879893
Provider Name (Legal Business Name): KATY KOTTABI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N WILMOT RD
TUCSON AZ
85711-2701
US

IV. Provider business mailing address

PO BOX 910221
DALLAS TX
75391-0221
US

V. Phone/Fax

Practice location:
  • Phone: 520-306-7708
  • Fax:
Mailing address:
  • Phone: 520-519-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: