Provider Demographics
NPI:1902172182
Name:COTTRELL, LAURA J (LCPC, ATR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:LCPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 WESTMORELAND DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6809 WESTMORELAND DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1611
Practice Address - Country:US
Practice Address - Phone:630-263-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health