Provider Demographics
NPI:1134417199
Name:COTHERN, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COTHERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 E 38TH PL
Mailing Address - Street 2:APT A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3359
Mailing Address - Country:US
Mailing Address - Phone:918-855-9853
Mailing Address - Fax:
Practice Address - Street 1:1437 E 38TH PL
Practice Address - Street 2:APT A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3359
Practice Address - Country:US
Practice Address - Phone:918-855-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health