Provider Demographics
NPI:1427239482
Name:COTTER, JOHN MARK (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:COTTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:32905 W 12 MILE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3342
Mailing Address - Country:US
Mailing Address - Phone:248-553-0770
Mailing Address - Fax:248-553-8116
Practice Address - Street 1:32905 W 12 MILE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3342
Practice Address - Country:US
Practice Address - Phone:248-553-0770
Practice Address - Fax:248-553-8116
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008484103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist