Provider Demographics
NPI:1659071330
Name:COTTON, REYSAN R (LPC)
Entity Type:Individual
Prefix:
First Name:REYSAN
Middle Name:R
Last Name:COTTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 NW BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-5190
Mailing Address - Country:US
Mailing Address - Phone:208-409-7122
Mailing Address - Fax:
Practice Address - Street 1:1815 AMERICAN LEGION BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3166
Practice Address - Country:US
Practice Address - Phone:208-590-1262
Practice Address - Fax:208-277-1342
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health