Healthcare Provider Details

I. General information

NPI: 1558720474
Provider Name (Legal Business Name): JESSICA R MONTOYA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA R CHAVEZ LMHC

II. Dates (important events)

Enumeration Date: 02/20/2016
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 260
ALBUQUERQUE NM
87120-2160
US

IV. Provider business mailing address

6105 JAMERS DR NW
ALBUQUERQUE NM
87120-3217
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2839
  • Fax: 505-295-2559
Mailing address:
  • Phone: 505-382-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0216901
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: