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General NPI Number Information
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NPI Number | 1881395036
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Entity Type | Organization
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Legal Business Name | MOTEN THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 1565 E TRINITY BLVD UNIT AA03
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City | MONTGOMERY
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State | AL
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Zip | 36106-2897
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Country | US
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Telephone | 334-310-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 4117 FITZPATRICK BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36116-4844
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Country | US
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Telephone | 773-354-3103
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRANDON MOTEN
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Credential | LPC
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Telephone | 773-354-3103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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