Healthcare Provider Details

I. General information

NPI: 1366380321
Provider Name (Legal Business Name): REBECCA JOYCE MONTOYA WRIGHT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W WHITE MOUNTAIN BLVD
LAKESIDE AZ
85929-6532
US

IV. Provider business mailing address

6626 ZIA LN
LAKESIDE AZ
85929-5008
US

V. Phone/Fax

Practice location:
  • Phone: 928-242-3860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-17154
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: