Provider Demographics
NPI:1376704189
Name:COTHERN, CHRISTOPHER SHAN (MS, LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SHAN
Last Name:COTHERN
Suffix:
Gender:M
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-9416
Mailing Address - Country:US
Mailing Address - Phone:601-373-9156
Mailing Address - Fax:
Practice Address - Street 1:1108 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MS
Practice Address - Zip Code:39170-9416
Practice Address - Country:US
Practice Address - Phone:601-373-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS570101YM0800X
MST0137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist