Provider Demographics
NPI:1114778453
Name:MONTESINOS, JOHANNA S
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:S
Last Name:MONTESINOS
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 1:3435 WILSHIRE BLVD STE 1840
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2004
Mailing Address - Country:US
Mailing Address - Phone:714-697-7729
Mailing Address - Fax:
Practice Address - Street 1:3435 WILSHIRE BLVD STE 1840
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2004
Practice Address - Country:US
Practice Address - Phone:714-697-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC16045101YM0800X
CAAMFT145018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health