Provider Demographics
NPI:1770816696
Name:MONTOYA, AMY JOHNNA (BSW/MA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JOHNNA
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:BSW/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 AGUILAR DR
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3903
Mailing Address - Country:US
Mailing Address - Phone:719-680-1392
Mailing Address - Fax:
Practice Address - Street 1:417 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3126
Practice Address - Country:US
Practice Address - Phone:719-846-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional