Provider Demographics
NPI:1790820363
Name:MONTES, JORGE RICARDO (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:RICARDO
Last Name:MONTES
Suffix:
Gender:M
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 71033
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79917-1033
Mailing Address - Country:US
Mailing Address - Phone:915-355-7958
Mailing Address - Fax:915-533-0105
Practice Address - Street 1:11450 ROJAS DR
Practice Address - Street 2:SUITE D13-14, SPACE 20
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6992
Practice Address - Country:US
Practice Address - Phone:915-355-7958
Practice Address - Fax:915-533-0105
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14642101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113112001Medicaid