Individual
CARMEN MOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1504 S TEXAS AVE, BRYAN, TX 77802-1015
(979) 822-6467
(979) 821-9448
Mailing address
100 S BURLESON DR, BRYAN, TX 77802-1341
(979) 822-6467
(979) 821-9448
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
65959
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65959
STATE LICENSE
TX
Enumeration date
02/16/2012
Last updated
02/16/2012
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