Healthcare Provider Details

I. General information

NPI: 1205979366
Provider Name (Legal Business Name): MRS. DAWN M MONTOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12475 NW STANIS LN STE 301
PORT ST LUCIE FL
34987-3063
US

IV. Provider business mailing address

12475 NW STANIS LN STE 301
PORT ST LUCIE FL
34987-3063
US

V. Phone/Fax

Practice location:
  • Phone: 772-828-9007
  • Fax:
Mailing address:
  • Phone: 772-828-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9540
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: