Provider Demographics
NPI:1144414764
Name:COTHRAN, ADAM CARROLL (MSW)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:CARROLL
Last Name:COTHRAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17675 S. MUSKOGEE AVE.
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465
Mailing Address - Country:US
Mailing Address - Phone:918-453-5000
Mailing Address - Fax:
Practice Address - Street 1:17675 S. MUSKOGEE AVE.
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74465
Practice Address - Country:US
Practice Address - Phone:918-453-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker