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General NPI Number Information
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NPI Number | 1184578114
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Entity Type | Individual
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Provider Name | JONATHAN DARRELL COTTRELL JR. LPCA
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Gender | Male
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 1105 JULIANNA CT STE 1
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7937
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Country | US
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Telephone | 270-769-3714
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Fax |
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Provider Business Mailing Address
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Address Line | 1119 BURNS RD
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City | RADCLIFF
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State | KY
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Zip | 40160-9307
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Country | US
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Telephone | 316-494-2258
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 305316
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License Number State | KY
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