Healthcare Provider Details

I. General information

NPI: 1275323644
Provider Name (Legal Business Name): TAMELYN MOTLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FOX DR STE 102
CHAMPAIGN IL
61820-8195
US

IV. Provider business mailing address

2101 FOX DR STE 102
CHAMPAIGN IL
61820-8195
US

V. Phone/Fax

Practice location:
  • Phone: 217-766-0258
  • Fax:
Mailing address:
  • Phone: 217-766-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178005045
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180017605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: