Basic Information
Provider Information
NPI: 1699144493
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONTSTREAM
FirstName: CHRISTIE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MS, LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 224 ALEXANDER ST
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146074000
CountryCode: US
TelephoneNumber: 5859227770
FaxNumber: 5859227246
Practice Location
Address1: 224 ALEXANDER ST
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146074000
CountryCode: US
TelephoneNumber: 5859227770
FaxNumber: 5859227246
Other Information
ProviderEnumerationDate: 09/22/2015
LastUpdateDate: 04/20/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X007870NYY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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