Provider Demographics
NPI:1730190752
Name:COTTEN, MARY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:COTTEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2458
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-7458
Mailing Address - Country:US
Mailing Address - Phone:817-573-5891
Mailing Address - Fax:
Practice Address - Street 1:201 E PEARL ST STE C-208
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2177
Practice Address - Country:US
Practice Address - Phone:817-573-5891
Practice Address - Fax:817-732-8015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM433837777Medicaid
TX0966426-05Medicaid
TX1730190752OtherNPI