Provider Demographics
NPI:1598539249
Name:MONTIEL, MONIQUE DEANNA (AMFT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:DEANNA
Last Name:MONTIEL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:DEANNA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2511
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-1511
Mailing Address - Country:US
Mailing Address - Phone:949-689-2478
Mailing Address - Fax:
Practice Address - Street 1:2130 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2422
Practice Address - Country:US
Practice Address - Phone:949-689-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist