Healthcare Provider Details

I. General information

NPI: 1750797403
Provider Name (Legal Business Name): LELIA MONTIEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 12/08/2019
Certification Date: 12/08/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST STE 104
STUDIO CITY CA
91604-2155
US

IV. Provider business mailing address

12143 LA MAIDA ST
NORTH HOLLYWOOD CA
91607-3620
US

V. Phone/Fax

Practice location:
  • Phone: 818-317-4624
  • Fax:
Mailing address:
  • Phone: 818-317-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number78360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: