Provider Demographics
NPI:1710187760
Name:COTTON, JUDA (LPCA)
Entity Type:Individual
Prefix:
First Name:JUDA
Middle Name:
Last Name:COTTON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4473 PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WADDY
Mailing Address - State:KY
Mailing Address - Zip Code:40076-6151
Mailing Address - Country:US
Mailing Address - Phone:502-829-0059
Mailing Address - Fax:
Practice Address - Street 1:250 ALPINE DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8880
Practice Address - Country:US
Practice Address - Phone:502-589-1100
Practice Address - Fax:502-589-8771
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid