Healthcare Provider Details

I. General information

NPI: 1083448658
Provider Name (Legal Business Name): THERESA ANGELINA MONTOYA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 DESI LOOP
BELEN NM
87002-8068
US

IV. Provider business mailing address

817 DESI LOOP
BELEN NM
87002-8068
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-4357
  • Fax:
Mailing address:
  • Phone: 575-835-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0620
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: