Provider Demographics
NPI:1679245732
Name:MONTANA, GABRIELLE ELISE (LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELISE
Last Name:MONTANA
Suffix:
Gender:F
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 SEMINOLE CENTRE CT STE 130
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5019
Mailing Address - Country:US
Mailing Address - Phone:815-914-4010
Mailing Address - Fax:
Practice Address - Street 1:3185 DEER POINT DR STE A
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3773
Practice Address - Country:US
Practice Address - Phone:608-873-7838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4631-226101YP2500X
WI8514-125101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional