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NPI Code Detail

MEDICARE: MR. TERRANCE MARK COTTLE M.A., L.M.S.W.

MEDICARE:  MR. TERRANCE MARK COTTLE  M.A., L.M.S.W.
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
11041C0700XClinical Social Worker6801061794MI

General Provider Information

NPI Number : 1740324813
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TERRANCE MARK COTTLE M.A., L.M.S.W.
Provider Business Mailing Address
First Line : 3395 HALLENIUS RD
Second Line :
City : GAYLORD
State : MI
Zip : 49735-7231
Country : US
Telephone Number : 989-732-4176
Fax Number :
Provider Business Practice Location Address
First Line : 1165 ELKVIEW, SUITE #3
Second Line :
City : GAYLORD
State : MI
Zip : 49735
Country : US
Telephone Number : 989-732-6761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2007
Last Update Date : 05/04/2026

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