Provider Demographics
NPI:1417378910
Name:MOTT, PARKER LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PARKER
Middle Name:LEE
Last Name:MOTT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S. DILLARD STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:407-347-0661
Mailing Address - Fax:407-347-0664
Practice Address - Street 1:310 S. DILLARD STREET
Practice Address - Street 2:SUITE 190
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787
Practice Address - Country:US
Practice Address - Phone:407-347-0661
Practice Address - Fax:407-347-0664
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8941103T00000X, 103TB0200X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling