Provider Demographics
NPI:1033644547
Name:WALLAH-MONTOYA, AVNEET
Entity Type:Individual
Prefix:
First Name:AVNEET
Middle Name:
Last Name:WALLAH-MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8430 W LAKE MEAD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7672
Mailing Address - Country:US
Mailing Address - Phone:702-815-6535
Mailing Address - Fax:
Practice Address - Street 1:8430 W LAKE MEAD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7672
Practice Address - Country:US
Practice Address - Phone:702-815-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-23
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health