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General NPI Number Information
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NPI Number | 1992078828
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Entity Type | Individual
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Provider Name | KEVIN J MONTAGUE MS, LPC, LSAC, LSW
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Gender | Male
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 100 POLK COUNTY PLZ STE 50
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City | BALSAM LAKE
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State | WI
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Zip | 54810-9071
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Country | US
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Telephone | 715-485-8862
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Fax | 715-485-8450
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Provider Business Mailing Address
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Address Line | 100 POLK COUNTY PLZ STE 50
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City | BALSAM LAKE
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State | WI
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Zip | 54810-9071
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Country | US
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Telephone | 715-485-8862
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Fax | 715-485-8450
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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 | 8078-120
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15908-132
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6332-125
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License Number State | WI
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