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General NPI Number Information
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NPI Number | 1215667571
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Entity Type | Individual
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Provider Name | STACEY MONTOYA LPC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 5838 W 21ST ST N STE 100D
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City | WICHITA
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State | KS
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Zip | 67205-1795
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Country | US
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Telephone | 316-535-7035
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Fax |
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Provider Business Mailing Address
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Address Line | 11822 W GRANT ST
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City | WICHITA
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State | KS
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Zip | 67209-4275
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Country | US
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Telephone | 316-880-1998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 04039
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License Number State | KS
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