Healthcare Provider Details

I. General information

NPI: 1114226057
Provider Name (Legal Business Name): COREY COTTON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BOARDMAN CANFIELD RD STE D
BOARDMAN OH
44512-4381
US

IV. Provider business mailing address

725 BOARDMAN CANFIELD RD STE D
BOARDMAN OH
44512-4381
US

V. Phone/Fax

Practice location:
  • Phone: 330-783-9690
  • Fax: 330-783-9693
Mailing address:
  • Phone: 330-783-9690
  • Fax: 330-783-9693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC 0701179
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: