Provider Demographics
NPI:1285979153
Name:COTNER ALLEN, DEE (MA, MDIV, STM LMFT)
Entity type:Individual
Prefix:
First Name:DEE
Middle Name:
Last Name:COTNER ALLEN
Suffix:
Gender:F
Credentials:MA, MDIV, STM LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5538
Mailing Address - Country:US
Mailing Address - Phone:371-251-3804
Mailing Address - Fax:
Practice Address - Street 1:3815 E 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5538
Practice Address - Country:US
Practice Address - Phone:317-251-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000566A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist