Provider Demographics
NPI:1851492359
Name:COTTON, IAN MARK (MFT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:MARK
Last Name:COTTON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SPRING ST
Mailing Address - Street 2:STE201
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5263
Mailing Address - Country:US
Mailing Address - Phone:858-627-7766
Mailing Address - Fax:619-698-0634
Practice Address - Street 1:4700 SPRING ST
Practice Address - Street 2:STE201
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5263
Practice Address - Country:US
Practice Address - Phone:858-627-7766
Practice Address - Fax:619-698-0634
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist