Provider Demographics
NPI:1134402886
Name:MONTOYA, MARSIOL (LPC)
Entity type:Individual
Prefix:
First Name:MARSIOL
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:SOLEDAD
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1251 15 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-9707
Mailing Address - Country:US
Mailing Address - Phone:575-590-3103
Mailing Address - Fax:
Practice Address - Street 1:1005 N 12TH ST STE 105
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3156
Practice Address - Country:US
Practice Address - Phone:970-241-6500
Practice Address - Fax:970-243-8835
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional