Provider Demographics
NPI:1124647839
Name:COTTLE, NATHAN R (PHD, MSW)
Entity type:Individual
Prefix:PROF
First Name:NATHAN
Middle Name:R
Last Name:COTTLE
Suffix:
Gender:M
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 E 300 S STE 113
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3844
Mailing Address - Country:US
Mailing Address - Phone:801-450-0193
Mailing Address - Fax:
Practice Address - Street 1:556 E 300 S STE 109
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3844
Practice Address - Country:US
Practice Address - Phone:801-450-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health