MEDICARE: MS. DEBORAH ANN MONTANA LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 28610	CA

General Provider Information

NPI Number	:	1164529855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH ANN MONTANA LMFT

Provider Business Mailing Address
First Line	:	5055 CANYON CREST DR
Second Line	:	SUITE # 206
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-6015
Country	:	US
Telephone Number	:	909-412-8335
Fax Number	:	951-684-6716

Provider Business Practice Location Address
First Line	:	5055 CANYON CREST DR
Second Line	:	SUITE # 206
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-6015
Country	:	US
Telephone Number	:	909-412-8335
Fax Number	:	951-684-6716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	02/06/2012

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