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General NPI Number Information
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NPI Number | 1245476753
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Entity Type | Individual
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Provider Name | AMY DIANE MONTAGUE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 74710 HIGHWAY 111 STE 102
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City | PALM DESERT
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State | CA
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Zip | 92260-3820
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Country | US
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Telephone | 310-497-7047
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Fax |
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Provider Business Mailing Address
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Address Line | 260 NEWPORT CENTER DR STE 209
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7520
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Country | US
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Telephone | 310-497-7047
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 16740
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License Number State | CA
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