MEDICARE: MICHELLE MONTANA LLMSW, CADC

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	1041C0700X	Clinical Social Worker	6851109195	MI

General Provider Information

NPI Number	:	1972974442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MONTANA LLMSW, CADC

Provider Business Mailing Address
First Line	:	5126 W GRAND RIVER AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48906-9168
Country	:	US
Telephone Number	:	517-580-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	5126 W GRAND RIVER AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48906-9168
Country	:	US
Telephone Number	:	517-580-2225
Fax Number	:

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

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	01/15/2026

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