Provider Demographics
NPI:1740617737
Name:MOTIFF, JAMES PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PETER
Last Name:MOTIFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:FENNVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49408-9751
Mailing Address - Country:US
Mailing Address - Phone:269-227-3761
Mailing Address - Fax:
Practice Address - Street 1:1614 WALKER RD
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408-9751
Practice Address - Country:US
Practice Address - Phone:269-227-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002454103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301002454OtherPSYCHOLOGIST LICENSE
MI0C045085Medicare PIN