Healthcare Provider Details

I. General information

NPI: 1154950640
Provider Name (Legal Business Name): YVETTE MONTOYA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 WHITE WATER RD
EL PRADO NM
87529-7438
US

IV. Provider business mailing address

PO BOX 1351
TAOS NM
87571-1351
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-6342
  • Fax:
Mailing address:
  • Phone: 505-463-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: YVETTE MONTOYA
Title or Position: PSYCHOTHERAPIST
Credential: LPCC
Phone: 505-463-6342