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NPI Code Detail

MEDICARE: MR. BRET MATTHEW COTTRELL B.A.

MEDICARE: MR. BRET MATTHEW COTTRELL B.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorRC00040545WA
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RC00040545OTHERWAREGISTERED COUNSELOR

General Provider Information

NPI Number : 1467561308
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRET MATTHEW COTTRELL B.A.
Provider Business Mailing Address
First Line : 540 W INTERNATIONAL AIRPORT RD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99518-1105
Country : US
Telephone Number : 907-561-5335
Fax Number :
Provider Business Practice Location Address
First Line : 540 W INTERNATIONAL AIRPORT RD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99518-1105
Country : US
Telephone Number : 907-561-5335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 12/02/2020

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