=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831502830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2014
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 574 CORTES ST.
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-1462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-747-4254
-----------------------------------------------------
Fax | 831-373-3821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 574 CORTES ST
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-747-1727
-----------------------------------------------------
Fax | 831-373-3821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MARY BETH PURI
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 208-250-2724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------