Provider Demographics
NPI:1730473778
Name:PRIES, MONTE GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:GEORGE
Last Name:PRIES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23736 BIRTCHER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1771
Mailing Address - Country:US
Mailing Address - Phone:714-558-9266
Mailing Address - Fax:
Practice Address - Street 1:23736 BIRTCHER DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1771
Practice Address - Country:US
Practice Address - Phone:714-558-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14614103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist