Healthcare Provider Details

I. General information

NPI: 1831093483
Provider Name (Legal Business Name): FELICIA MONTOYA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 W PARKSIDE LN
PHOENIX AZ
85027-1228
US

IV. Provider business mailing address

7113 W UTOPIA RD
GLENDALE AZ
85308-5675
US

V. Phone/Fax

Practice location:
  • Phone: 480-798-2050
  • Fax: 480-546-3728
Mailing address:
  • Phone: 602-301-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: