MEDICARE: DR. PHYLLIS MONTAVON PSY.D., LCSW, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LADC - 01322-L	NV
2	1041C0700X	Clinical Social Worker	LCSW 7031-C	NV

General Provider Information

NPI Number	:	1235364522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHYLLIS MONTAVON PSY.D., LCSW, LCADC

Provider Business Mailing Address
First Line	:	5172 JEWEL CANYON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-8328
Country	:	US
Telephone Number	:	702-712-5431
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 E RUSSELL RD STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2201
Country	:	US
Telephone Number	:	702-712-5431
Fax Number	:	702-297-6599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	02/07/2025

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