Provider Demographics
NPI:1457085276
Name:MONTEMAYOR, ADALICIA (MED, LPC)
Entity Type:Individual
Prefix:MISS
First Name:ADALICIA
Middle Name:
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4466
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-4466
Mailing Address - Country:US
Mailing Address - Phone:956-929-7094
Mailing Address - Fax:
Practice Address - Street 1:619 N ALTEZA DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-2050
Practice Address - Country:US
Practice Address - Phone:956-328-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional