Provider Demographics
NPI:1316403082
Name:MONTOYA, KYLIE (LPCC)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 CABEZON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1576
Mailing Address - Country:US
Mailing Address - Phone:505-717-1155
Mailing Address - Fax:505-717-1473
Practice Address - Street 1:2441 CABEZON BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1576
Practice Address - Country:US
Practice Address - Phone:505-717-1155
Practice Address - Fax:505-717-1473
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0202521101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health