Active NPI
Jack Cottom, LPC
- Professional Counselor
- Philadelphia, PA
National Provider Identifier
1457755696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC009399
- Practice address
- 2000 Spring Garden St
1F
Philadelphia, PA 19130-3994 - Phone
- (404) 918-6042
- NPI assigned
- Oct 17, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC009399 | PA | Primary |
Addresses
Primary practice location
2000 Spring Garden St
1F
Philadelphia, PA 19130-3994
Mailing address
2000 Spring Garden St
1F
Philadelphia, PA 19130-3994
Phone (404) 918-6042
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC009399 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484784000000",
"number": "1457755696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 SPRING GARDEN ST",
"address_2": "1F",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191303994",
"telephone_number": "404-918-6042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 SPRING GARDEN ST",
"address_2": "1F",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191303994",
"telephone_number": "404-918-6042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COTTOM",
"first_name": "JACK",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-17",
"last_updated": "2017-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC009399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
- Cottman Ambulatory Surgery Center (Wills Surgery Center of the Northeast)
- Cottman Chiropractic Center P.C. (Holme Circle Chiropractic)
- Cottman Medical and Rehabilitation Associates
- Cottman Physician Associates PC
- Kassandra Ivette Cotto
- Matthew Cotton-Betteridge, DO
- Caroline Cotton, MD
- Jesse Cotton
- Lauren Cotton, OTR/L
- Nehemiah Jaron Cotton, BA OF PSYCHOLOGY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.