Provider Demographics
NPI:1750888061
Name:COTANT, MARILYN JEAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:JEAN
Last Name:COTANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 E 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2203
Mailing Address - Country:US
Mailing Address - Phone:307-532-4085
Mailing Address - Fax:
Practice Address - Street 1:918 E 27TH AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2203
Practice Address - Country:US
Practice Address - Phone:307-532-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty