Provider Demographics
NPI:1245076272
Name:MONTEZ, OLIVIA NICOLE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:NICOLE
Last Name:MONTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 CHAMBERS CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1301
Mailing Address - Country:US
Mailing Address - Phone:614-800-1940
Mailing Address - Fax:
Practice Address - Street 1:924 CHAMBERS CIR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1301
Practice Address - Country:US
Practice Address - Phone:614-800-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional