Healthcare Provider Details

I. General information

NPI: 1437820008
Provider Name (Legal Business Name): ELIZABETH COTTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 STATE ST
SAINT JOSEPH MI
49085-1369
US

IV. Provider business mailing address

2800 S LAKESHORE DR
SAINT JOSEPH MI
49085-2932
US

V. Phone/Fax

Practice location:
  • Phone: 630-473-4770
  • Fax: 269-883-4050
Mailing address:
  • Phone: 630-473-4770
  • Fax: 630-473-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6351004977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: