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General NPI Number Information
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NPI Number | 1235525254
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Entity Type | Individual
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Provider Name | CHARISE MAE MONGE M.ED, LAC, LMHCA
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Gender | Female
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 2921 N GRAND AVE STE 9
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City | NOGALES
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State | AZ
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Zip | 85621-3921
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Country | US
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Telephone | 520-224-4793
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Fax |
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Provider Business Mailing Address
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Address Line | 3308 E 11TH AVE APT C211
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City | SPOKANE
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State | WA
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Zip | 99202-5445
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Country | US
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Telephone | 520-224-4793
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MC60501445
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LAC20308
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC20308
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC-60501445
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61463314
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-20308
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License Number State | AZ
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