Provider Demographics
NPI:1568830776
Name:MONTES, LAURETTA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURETTA
Middle Name:K
Last Name:MONTES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MAPLE CT STE 112
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3517
Mailing Address - Country:US
Mailing Address - Phone:805-746-7136
Mailing Address - Fax:
Practice Address - Street 1:290 MAPLE CT STE 112
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3517
Practice Address - Country:US
Practice Address - Phone:805-746-7136
Practice Address - Fax:805-947-1007
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY32160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSB94021087OtherBOARD OF PSYCHOLOGY PSYCHOLOGICAL ASSISTANT REGISTRATION