Healthcare Provider Details

I. General information

NPI: 1265741102
Provider Name (Legal Business Name): JILL COLLEEN MONTOYA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

1990 E LOHMAN AVE
LAS CRUCES NM
88001-3172
US

V. Phone/Fax

Practice location:
  • Phone: 575-639-4930
  • Fax: 575-233-6275
Mailing address:
  • Phone: 575-639-4930
  • Fax: 575-233-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0159001
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: