Healthcare Provider Details

I. General information

NPI: 1669742227
Provider Name (Legal Business Name): JAMIE MONTAG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 EISENHOWER BLVD
JOHNSTOWN PA
15904-3327
US

IV. Provider business mailing address

1322 EISENHOWER BLVD
JOHNSTOWN PA
15904-3307
US

V. Phone/Fax

Practice location:
  • Phone: 814-266-8840
  • Fax: 814-266-2176
Mailing address:
  • Phone: 814-266-8840
  • Fax: 814-266-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC006800
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: