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General NPI Number Information
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NPI Number | 1003458613
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Entity Type | Individual
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Provider Name | BETH COTTRELL
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Gender | Female
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 444 STILLWATER AVE STE 104
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City | BANGOR
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State | ME
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Zip | 04401-3500
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Country | US
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Telephone | 207-659-6510
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Fax |
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Provider Business Mailing Address
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Address Line | 261 WOODLAND AVE
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City | OLD TOWN
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State | ME
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Zip | 04468-5925
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Country | US
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Telephone | 207-356-5478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC5830
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License Number State | ME
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