MEDICARE: MRS. CYNTHIA MOTA LMFT, CADC-P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	01222	NV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	00463	NV

General Provider Information

NPI Number	:	1649562943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA MOTA LMFT, CADC-P

Provider Business Mailing Address
First Line	:	1801 COCHRAN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3506
Country	:	US
Telephone Number	:	702-610-0382
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 ALTA DR
Second Line	:	SUITE 4
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4163
Country	:	US
Telephone Number	:	702-474-6450
Fax Number	:	702-474-6463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	05/09/2013

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