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NPI Code Detail

MEDICARE: SUSAN MONTIETH

MEDICARE: SUSAN MONTIETH
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) CounselorCP00005879WA
2101YM0800XMental Health CounselorLH00010927WA

General Provider Information

NPI Number : 1639644461
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MONTIETH
Provider Business Mailing Address
First Line : PO BOX 142123
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99214-2001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14819 E MISSION AVE
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99216-1960
Country : US
Telephone Number : 509-315-9791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2018
Last Update Date : 10/08/2018

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Directions to “ SUSAN MONTIETH ” Practice Location

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