Healthcare Provider Details

I. General information

NPI: 1265847271
Provider Name (Legal Business Name): JULIE KAY MOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CENTENNIAL BLVD
SPRINGFIELD OR
97477
US

IV. Provider business mailing address

1258 HIGH ST
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 458-210-2306
  • Fax:
Mailing address:
  • Phone: 541-342-8437
  • Fax: 458-201-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5941
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: