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NPI Code Detail

MEDICARE: MAXINE MONTOYA LCDC

MEDICARE: MAXINE MONTOYA LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor9640TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619318409
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAXINE MONTOYA LCDC
Provider Business Mailing Address
First Line : 1219 BARRANCA DR
Second Line :
City : EL PASO
State : TX
Zip : 79935-4601
Country : US
Telephone Number : 915-779-5600
Fax Number : 915-779-5605
Provider Business Practice Location Address
First Line : 1219 BARRANCA DR
Second Line :
City : EL PASO
State : TX
Zip : 79935-4601
Country : US
Telephone Number : 915-779-5600
Fax Number : 915-779-5605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2013
Last Update Date : 07/09/2013

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Directions to “ MAXINE MONTOYA LCDC” Practice Location

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