Basic Information
| Provider Information | |||||||||
| NPI: | 1124544028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTOYA | ||||||||
| FirstName: | GENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 3RD AVE SE | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598642817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065317398 | ||||||||
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| Practice Location | |||||||||
| Address1: | 308 MISSION DR | ||||||||
| Address2: | |||||||||
| City: | SAINT IGNATIUS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598659676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067453525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2017 | ||||||||
| LastUpdateDate: | 08/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | BH-LCSW-LIC-23929 | MT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.