Healthcare Provider Details

I. General information

NPI: 1497960116
Provider Name (Legal Business Name): TRISHA MAE MONTOYA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

1106 E SAN MIGUEL ST
COLORADO SPRINGS CO
80903-2706
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5297
  • Fax:
Mailing address:
  • Phone: 719-210-9519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992779
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: