Provider Demographics
NPI:1902481906
Name:MOTEN THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:MOTEN THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:773-354-3103
Mailing Address - Street 1:4117 FITZPATRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-4844
Mailing Address - Country:US
Mailing Address - Phone:773-354-3103
Mailing Address - Fax:
Practice Address - Street 1:4117 FITZPATRICK BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-4844
Practice Address - Country:US
Practice Address - Phone:773-354-3103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty