Provider Demographics
NPI:1023294410
Name:COTTER, GWEN (MFT)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:COTTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 DEL MONTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571
Mailing Address - Country:US
Mailing Address - Phone:707-374-4091
Mailing Address - Fax:
Practice Address - Street 1:393 DEL MONTE DRIVE
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571
Practice Address - Country:US
Practice Address - Phone:707-374-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health