Provider Demographics
NPI:1912275363
Name:COTTAGE COUNSELORS LLC
Entity Type:Organization
Organization Name:COTTAGE COUNSELORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCCLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:612-226-7890
Mailing Address - Street 1:17113 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-1100
Mailing Address - Country:US
Mailing Address - Phone:855-456-8567
Mailing Address - Fax:
Practice Address - Street 1:17113 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-1100
Practice Address - Country:US
Practice Address - Phone:855-456-8567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health