Provider Demographics
NPI:1770225773
Name:MONTELLANO, JOSEPH ANTHONY (LCDC, LPC-A)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:MONTELLANO
Suffix:
Gender:M
Credentials:LCDC, LPC-A
Other - Prefix:
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:MONTELLANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6238 PELICAN CORAL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1635
Mailing Address - Country:US
Mailing Address - Phone:210-309-0739
Mailing Address - Fax:
Practice Address - Street 1:3615 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5914
Practice Address - Country:US
Practice Address - Phone:210-314-6473
Practice Address - Fax:210-314-8676
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)