Doctor Name: | ANAKA 'TESS' COTHRON |
NPI Number: | 1639547037 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 800 N Main St Tompkinsville, KY - 421671037 |
Business Phone Number: | 2709015000 |
Business Fax Number: | 2704875948 |
Mailing Address: | 380 Suwannee Trail St, BOWLING GREEN |
State: | KY |
Postal Code: | 421037956 |
Phone Number: | 2709015000 |
Fax Number: | 2708425268 |
NPI Enumeration Date: | 09/02/2015 |
NPI Last Update Date: | 09/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |