Provider Demographics
NPI:1174138937
Name:COTNER, NEAL F
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:F
Last Name:COTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 E HUNTZINGER RD
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-9712
Mailing Address - Country:US
Mailing Address - Phone:509-952-4770
Mailing Address - Fax:
Practice Address - Street 1:493 E HUNTZINGER RD
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-9712
Practice Address - Country:US
Practice Address - Phone:509-952-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60807884101YM0800X
WA300673A101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool