Provider Demographics
NPI:1356674337
Name:MONTEZ, MARINA L
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:L
Last Name:MONTEZ
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 1:6214 WARHAWK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3940
Mailing Address - Country:US
Mailing Address - Phone:859-319-1586
Mailing Address - Fax:
Practice Address - Street 1:8607 WURZBACH RD
Practice Address - Street 2:V-201-C
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1303
Practice Address - Country:US
Practice Address - Phone:859-319-1586
Practice Address - Fax:210-699-9282
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health