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General NPI Number Information
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NPI Number | 1295271120
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Entity Type | Organization
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Legal Business Name | MELINDA MOTTER,LLC
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 1310 OLD HIGHWAY 63 S STE 1
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City | COLUMBIA
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State | MO
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Zip | 65201-6078
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Country | US
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Telephone | 573-874-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 OLD HIGHWAY 63 S STE 1
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City | COLUMBIA
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State | MO
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Zip | 65201-6078
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Country | US
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Telephone | 573-874-8818
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MELINDA MOTTER
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Credential | LPC
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Telephone | 573-874-8818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2010041702
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License Number State | MO
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