Provider Demographics
NPI:1164833356
Name:MOTT, MELISSA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:MOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4525 COLE AVE APT 1109
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4217
Mailing Address - Country:US
Mailing Address - Phone:208-520-4776
Mailing Address - Fax:
Practice Address - Street 1:5120 LEGACY DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3399
Practice Address - Country:US
Practice Address - Phone:469-613-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-10
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT17842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry