Healthcare Provider Details

I. General information

NPI: 1740616242
Provider Name (Legal Business Name): JENNIFER ANN MOTT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 NORTHRUP WAY SUITE 105
BELLEVUE WA
98004-1438
US

IV. Provider business mailing address

PO BOX 1278
LINCOLNTON NC
28093-1278
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-5659
  • Fax: 425-274-0948
Mailing address:
  • Phone: 727-800-2332
  • Fax: 727-800-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60817221
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: