MEDICARE: MS. BRANDEN LARK MOTT LPC, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LAC-13465	AZ
2	101YM0800X	Mental Health Counselor	LPCC13241	CA
3	101YM0800X	Mental Health Counselor	LPC-15269	AZ

General Provider Information

NPI Number	:	1093028664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRANDEN LARK MOTT LPC, LPCC

Provider Business Mailing Address
First Line	:	750 E. NORTHERN AVE
Second Line	:	#2066
City	:	PHOENIX
State	:	AZ
Zip	:	85020
Country	:	US
Telephone Number	:	480-405-7044
Fax Number	:	480-317-9867

Provider Business Practice Location Address
First Line	:	750 E. NORTHERN AVE
Second Line	:	#2066
City	:	PHOENIX
State	:	AZ
Zip	:	85020
Country	:	US
Telephone Number	:	480-405-7044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	01/15/2026

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