Provider Demographics
NPI:1932110251
Name:MOTTYS, JOAN K (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:K
Last Name:MOTTYS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 W 64TH ST
Mailing Address - Street 2:#202
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3168
Mailing Address - Country:US
Mailing Address - Phone:630-373-4527
Mailing Address - Fax:630-435-0377
Practice Address - Street 1:59 W 64TH ST
Practice Address - Street 2:#202
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-3168
Practice Address - Country:US
Practice Address - Phone:630-373-4527
Practice Address - Fax:630-435-0377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02227679OtherBLUE CROSS/BLUE SHIELD