Basic Information
| Provider Information | |||||||||
| NPI: | 1194065912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOTE | ||||||||
| FirstName: | VIONNE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 W B ST STE D | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417621971 | ||||||||
| FaxNumber: | 5417621974 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 W B ST STE D | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417621971 | ||||||||
| FaxNumber: | 5417621974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2013 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-13021 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.