Provider Demographics
NPI:1497803068
Name:MOTTERN, RICHARD CHARLES (MA,LPC,)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CHARLES
Last Name:MOTTERN
Suffix:
Gender:M
Credentials:MA,LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 W MISSISSIPPI AVE
Mailing Address - Street 2:F21A
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4550
Mailing Address - Country:US
Mailing Address - Phone:303-937-3478
Mailing Address - Fax:720-851-5773
Practice Address - Street 1:7500 W MISSISSIPPI AVE
Practice Address - Street 2:F21A
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4550
Practice Address - Country:US
Practice Address - Phone:303-937-3478
Practice Address - Fax:720-851-5773
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional