Healthcare Provider Details

I. General information

NPI: 1841159522
Provider Name (Legal Business Name): MICHAEL MONTOYA LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAN PEDRO DR NE
ALBUQUERQUE NM
87110-6734
US

IV. Provider business mailing address

12100 MENAUL BLVD NE APT B
ALBUQUERQUE NM
87112-2423
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-0717
  • Fax:
Mailing address:
  • Phone: 612-999-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2026-0033
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: