Healthcare Provider Details

I. General information

NPI: 1801465760
Provider Name (Legal Business Name): EMILEE DEAN MONTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BROADUS AVE # 100
GREENVILLE SC
29601-3040
US

IV. Provider business mailing address

3130 TSALI CIR
GREENVILLE SC
29601-1163
US

V. Phone/Fax

Practice location:
  • Phone: 803-335-0718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number301739
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: