Provider Demographics
NPI:1780818484
Name:MOTLEY, SUSANNE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 EMBARCADERO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-1405
Mailing Address - Country:US
Mailing Address - Phone:916-933-4609
Mailing Address - Fax:916-933-4600
Practice Address - Street 1:895 EMBARCADERO DR STE 105
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-1405
Practice Address - Country:US
Practice Address - Phone:916-933-4609
Practice Address - Fax:916-933-4600
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41310106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist