Provider Demographics
NPI:1881127850
Name:MOTTA, GAYLYNN
Entity type:Individual
Prefix:
First Name:GAYLYNN
Middle Name:
Last Name:MOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 KEITH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:AR
Mailing Address - Zip Code:90623
Mailing Address - Country:US
Mailing Address - Phone:714-308-0321
Mailing Address - Fax:
Practice Address - Street 1:7512 KEITH CIRCLE
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623
Practice Address - Country:US
Practice Address - Phone:714-308-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS165521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical