Provider Demographics
NPI:1104012970
Name:COTTAM PSYCHOLOGICAL SERVICES P.C.
Entity Type:Organization
Organization Name:COTTAM PSYCHOLOGICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:COLEGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-331-8085
Mailing Address - Street 1:2730 S. 87TH AVE.
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3045
Mailing Address - Country:US
Mailing Address - Phone:402-331-8085
Mailing Address - Fax:402-331-8265
Practice Address - Street 1:2730 S. 87TH AVE.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3045
Practice Address - Country:US
Practice Address - Phone:402-331-8085
Practice Address - Fax:402-331-8265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COTTAM PSYCHOLOGICAL SERVICES P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-14
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099163Medicare PIN