MEDICARE: MALLORY KAELYN MOTT

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
2	101YM0800X	Mental Health Counselor	LH61513165	WA

General Provider Information

NPI Number	:	1598355570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY KAELYN MOTT

Provider Business Mailing Address
First Line	:	1121 N ARGONNE RD STE 103
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-2686
Country	:	US
Telephone Number	:	509-863-6906
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 N ARGONNE RD STE 103
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-2686
Country	:	US
Telephone Number	:	509-863-6906
Fax Number	:

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

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	04/01/2025

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Directions to “ MALLORY KAELYN MOTT ” Practice Location

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