Provider Demographics
NPI:1902212681
Name:MOTT, ALVIN (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:MOTT
Suffix:
Gender:M
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3916
Mailing Address - Country:US
Mailing Address - Phone:972-353-9404
Mailing Address - Fax:940-898-8527
Practice Address - Street 1:1512 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3916
Practice Address - Country:US
Practice Address - Phone:972-353-9404
Practice Address - Fax:940-898-8527
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS335881101Y00000X
MS54965225800000X
MS1903101YP2500X
TX74731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist