Healthcare Provider Details

I. General information

NPI: 1508036286
Provider Name (Legal Business Name): MICHELLE MARIE MONTOYA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W. MAIN ST
KUNA ID
83634
US

IV. Provider business mailing address

2146 W TRESTLE DR
MERIDIAN ID
83646-1592
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-9001
  • Fax: 208-922-3778
Mailing address:
  • Phone: 208-288-1453
  • Fax: 208-922-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC3876
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: