Provider Demographics
NPI:1710289962
Name:MOTTA, MICHELLE DENISE (MA,, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DENISE
Last Name:MOTTA
Suffix:
Gender:F
Credentials:MA,, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 CALLE MONTERA
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7960
Mailing Address - Country:US
Mailing Address - Phone:858-395-7212
Mailing Address - Fax:760-294-0494
Practice Address - Street 1:16870 W BERNARDO DR STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1678
Practice Address - Country:US
Practice Address - Phone:858-395-7212
Practice Address - Fax:760-294-0494
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-20
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49253106H00000X
CALMFT49253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist