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General NPI Number Information
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NPI Number | 1891283859
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Entity Type | Individual
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Provider Name | ALICE M MONTOYA CACIII
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Gender | Female
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 720 N MAIN ST STE 240
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City | PUEBLO
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State | CO
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Zip | 81003-3046
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Country | US
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Telephone | 719-569-7909
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Fax |
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Provider Business Mailing Address
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Address Line | 27108 WOBURN ABBEY DR
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City | PUEBLO
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State | CO
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Zip | 81006-9762
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Country | US
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Telephone | 719-821-6830
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0007268
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License Number State | CO
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