Provider Demographics
NPI:1134384274
Name:MOTEN, ROSALYNN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ROSALYNN
Middle Name:MARIE
Last Name:MOTEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 GOLFVIEW DR
Mailing Address - Street 2:APT 202
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3919
Mailing Address - Country:US
Mailing Address - Phone:313-719-1649
Mailing Address - Fax:248-792-3042
Practice Address - Street 1:2215 GOLFVIEW DR
Practice Address - Street 2:APT 202
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3919
Practice Address - Country:US
Practice Address - Phone:313-719-1649
Practice Address - Fax:248-792-3042
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011759103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM80840OtherPSYCHOLOGIST