Healthcare Provider Details

I. General information

NPI: 1841981909
Provider Name (Legal Business Name): NICOLE R MONTOYA LSAA, CPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MADEIRA DR SE
ALBUQUERQUE NM
87108-2963
US

IV. Provider business mailing address

3321 CANDELARIA RD NE STE 250
ALBUQUERQUE NM
87107-1966
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-1538
  • Fax: 505-242-5302
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0572
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1495
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: