Provider Demographics
NPI:1205039930
Name:MARY ANN COTTEN AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MARY ANN COTTEN AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:575-439-1550
Mailing Address - Street 1:1408 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5105
Mailing Address - Country:US
Mailing Address - Phone:575-439-1550
Mailing Address - Fax:575-439-1552
Practice Address - Street 1:1408 8TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5105
Practice Address - Country:US
Practice Address - Phone:575-439-1550
Practice Address - Fax:575-439-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0791103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4338377Medicaid
NM300521153Medicare PIN