Provider Demographics
NPI:1295271120
Name:MELINDA MOTTER,LLC
Entity type:Organization
Organization Name:MELINDA MOTTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-874-8818
Mailing Address - Street 1:1310 OLD HIGHWAY 63 S STE 1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6078
Mailing Address - Country:US
Mailing Address - Phone:573-874-8818
Mailing Address - Fax:
Practice Address - Street 1:1310 OLD HIGHWAY 63 S STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6078
Practice Address - Country:US
Practice Address - Phone:573-874-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1558664268Medicaid