Provider Demographics
NPI:1831685924
Name:MOTT, MICHELLE IRENE (LAC, LPC-MH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:IRENE
Last Name:MOTT
Suffix:
Gender:F
Credentials:LAC, LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3601
Mailing Address - Country:US
Mailing Address - Phone:605-580-1092
Mailing Address - Fax:
Practice Address - Street 1:703 4TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3601
Practice Address - Country:US
Practice Address - Phone:605-580-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH7226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health