Healthcare Provider Details

I. General information

NPI: 1336284124
Provider Name (Legal Business Name): IRIANNA MONTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2494 PENNINGTON CREEK RD
SAN LUIS OBISPO CA
93405-7841
US

IV. Provider business mailing address

PO BOX 641
ATASCADERO CA
93423-0641
US

V. Phone/Fax

Practice location:
  • Phone: 805-782-7388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number62520
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT112736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: