Provider Demographics
NPI:1821466210
Name:MONTOYA, JAMES (LBSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-5986
Mailing Address - Country:US
Mailing Address - Phone:936-564-8611
Mailing Address - Fax:936-462-8080
Practice Address - Street 1:1108 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-5986
Practice Address - Country:US
Practice Address - Phone:936-564-8611
Practice Address - Fax:936-462-8080
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39189104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker