Healthcare Provider Details

I. General information

NPI: 1104755362
Provider Name (Legal Business Name): MOTIVATED MENTAL PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W ADAMS AVE STE 213
SISTERS OR
97759-2517
US

IV. Provider business mailing address

1255 W HILL AVE
SISTERS OR
97759-3134
US

V. Phone/Fax

Practice location:
  • Phone: 801-628-3881
  • Fax:
Mailing address:
  • Phone: 801-628-3881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: CHRIS TITTLE
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LPC, CMHC
Phone: 801-628-3881