Provider Demographics
NPI:1588938153
Name:MOTTUS, KEVIN NEIL (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:NEIL
Last Name:MOTTUS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 CAMDEN AVE
Mailing Address - Street 2:#209
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4456
Mailing Address - Country:US
Mailing Address - Phone:310-780-2186
Mailing Address - Fax:
Practice Address - Street 1:6651 BALBOA BLVD
Practice Address - Street 2:BLDG. A
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5529
Practice Address - Country:US
Practice Address - Phone:818-758-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS192941041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool