Provider Demographics
NPI:1023465572
Name:MOTEN, STEPHEN JR (EDS)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:MOTEN
Suffix:JR
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 PYRAMID PKWY APT 42
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2154
Mailing Address - Country:US
Mailing Address - Phone:863-838-0527
Mailing Address - Fax:
Practice Address - Street 1:1001 E BAKER ST STE 200
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3700
Practice Address - Country:US
Practice Address - Phone:813-754-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health