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General NPI Number Information
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NPI Number | 1104553320
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Entity Type | Individual
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Provider Name | JENNIFER COTHRAN M.S.
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Gender | Female
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Dates
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Enumeration Date | 08/07/2022
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Last Update Date | 08/07/2022
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Provider Practice Location Address
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Address Line | 1020 N BOOMER RD STE B
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City | STILLWATER
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State | OK
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Zip | 74075-3508
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Country | US
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Telephone | 405-937-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 707 N DRYDEN CIR
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City | STILLWATER
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State | OK
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Zip | 74075-7107
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Country | US
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Telephone | 580-317-7633
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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