Provider Demographics
NPI:1033973300
Name:MONTENEGRO, OSSIEL DARIO JR
Entity Type:Individual
Prefix:
First Name:OSSIEL
Middle Name:DARIO
Last Name:MONTENEGRO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14508 NE 20TH AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6418
Mailing Address - Country:US
Mailing Address - Phone:360-397-9211
Mailing Address - Fax:
Practice Address - Street 1:14508 NE 20TH AVE STE 305
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6418
Practice Address - Country:US
Practice Address - Phone:360-397-9211
Practice Address - Fax:360-397-4351
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor