Provider Demographics
NPI:1205976164
Name:COTTRELL, KIMBERLY JEAN (LADC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JEAN
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4122
Mailing Address - Country:US
Mailing Address - Phone:918-583-3520
Mailing Address - Fax:
Practice Address - Street 1:1201 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4122
Practice Address - Country:US
Practice Address - Phone:918-583-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)