Healthcare Provider Details

I. General information

NPI: 1609975671
Provider Name (Legal Business Name): J CRAIG COTTRELL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 S 9TH ST
KALAMAZOO MI
49009-7258
US

IV. Provider business mailing address

2008 LAKEWAY AVE
KALAMAZOO MI
49001-5124
US

V. Phone/Fax

Practice location:
  • Phone: 269-552-9534
  • Fax:
Mailing address:
  • Phone: 269-552-9534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801018152
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: