Provider Demographics
NPI:1851669261
Name:ORTBALS, CRISTA MONTGOMERY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CRISTA
Middle Name:MONTGOMERY
Last Name:ORTBALS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CRISTA
Other - Middle Name:MARIE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1 JEFFERSON BARRACKS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-4181
Mailing Address - Country:US
Mailing Address - Phone:314-894-6604
Mailing Address - Fax:
Practice Address - Street 1:1 JEFFERSON BARRACKS DR BLDG 51E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-894-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009038745103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical