Basic Information
| Provider Information | |||||||||
| NPI: | 1275612327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOTEN-ELLIOTT | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 HANCOCK ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897973400 | ||||||||
| FaxNumber: | 9897990206 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HANCOCK ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897973400 | ||||||||
| FaxNumber: | 9897990206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801085274 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 6801085274 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 382143740 | 01 | MI | TAX ID | OTHER | 1016815 | 01 | MI | MCLAREN | OTHER | 730195 | 05 | MI | MEDICAID |