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General NPI Number Information
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NPI Number | 1437212156
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Entity Type | Individual
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Provider Name | LARUE R MONTANYE D.ED.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 355 BROAD ST
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City | MONTOURSVILLE
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State | PA
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Zip | 17754-2221
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Country | US
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Telephone | 570-368-2624
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Fax | 570-368-2212
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Provider Business Mailing Address
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Address Line | 355 BROAD ST P.O. BOX 125
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City | MONTOURSVILLE
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State | PA
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Zip | 17754-2221
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Country | US
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Telephone | 570-368-2624
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Fax | 570-368-2212
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS002406L
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License Number State | PA
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