Healthcare Provider Details

I. General information

NPI: 1508164617
Provider Name (Legal Business Name): SANDRA TERESE MONTALVO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PYOTT RD STE 101
CRYSTAL LAKE IL
60014-8717
US

IV. Provider business mailing address

10012 MARVIN DR
HUNTLEY IL
60142-2307
US

V. Phone/Fax

Practice location:
  • Phone: 815-893-9424
  • Fax:
Mailing address:
  • Phone: 847-977-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007545
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: