Provider Demographics
NPI:1174665921
Name:FETCH, MONTY JAY (MA COUNSELING PSYCH)
Entity Type:Individual
Prefix:MR
First Name:MONTY
Middle Name:JAY
Last Name:FETCH
Suffix:
Gender:M
Credentials:MA COUNSELING PSYCH
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Mailing Address - Street 1:1850 NE LOTUS DR
Mailing Address - Street 2:APARTMENT 8 A
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6151
Mailing Address - Country:US
Mailing Address - Phone:541-350-1896
Mailing Address - Fax:
Practice Address - Street 1:63360 NW BRITTA ST STE 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9475
Practice Address - Country:US
Practice Address - Phone:541-318-4845
Practice Address - Fax:541-318-5156
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health