Basic Information
| Provider Information | |||||||||
| NPI: | 1497266787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTEZ | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCPC, LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 S 27TH ST | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591014227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062473350 | ||||||||
| FaxNumber: | 4062473389 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 S 27TH ST | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591014227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062473350 | ||||||||
| FaxNumber: | 4062473389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2017 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/19/2018 | ||||||||
| NPIReactivationDate: | 07/31/2018 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | BBH-LAC-LIC-25485 | MT | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | BBH-LCPC-LIC-30837 | MT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.