Provider Demographics
NPI:1225460421
Name:MONTANEZ, MARCEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCEL
Middle Name:
Last Name:MONTANEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 BUENA VIDA CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5096
Mailing Address - Country:US
Mailing Address - Phone:575-405-1320
Mailing Address - Fax:
Practice Address - Street 1:1220 STEWART STREET
Practice Address - Street 2:O'DONNELL HALL, RM 047
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003
Practice Address - Country:US
Practice Address - Phone:575-571-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0139181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health