Provider Demographics
NPI:1689217507
Name:MONTALVO, ADA (MENTAL HEALTH COUNSE)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:MISS
Other - First Name:ADA
Other - Middle Name:
Other - Last Name:ARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7509 KEY LARGO DR APT 411
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6900
Mailing Address - Country:US
Mailing Address - Phone:813-363-1631
Mailing Address - Fax:
Practice Address - Street 1:510 COACH LN
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3717
Practice Address - Country:US
Practice Address - Phone:646-358-6816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19397101YM0800X
WAMC61491834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19397OtherPROVISIONAL MENTAL HEALTH COUNSELOR LICENSE