MEDICARE: MELODY MONTANO LP, PHD

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	101YM0800X	Mental Health Counselor	69910	TX
2	101YP2500X	Professional Counselor	69910	TX
3	103T00000X	Psychologist	40236	TX

General Provider Information

NPI Number	:	1780017475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY MONTANO LP, PHD

Provider Business Mailing Address
First Line	:	17503 LA CANTERA PKWY STE 104-627
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-8207
Country	:	US
Telephone Number	:	210-614-4990
Fax Number	:	210-614-4991

Provider Business Practice Location Address
First Line	:	5522 LONE STAR PKWY STE 330
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6719
Country	:	US
Telephone Number	:	210-614-4990
Fax Number	:	210-614-4991

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

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	01/16/2025

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