Provider Demographics
NPI:1336638931
Name:ANGEL MONTFORT, PSY.D., LLC
Entity Type:Organization
Organization Name:ANGEL MONTFORT, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:MONTFORT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-563-6526
Mailing Address - Street 1:20747 STERLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-4317
Mailing Address - Country:US
Mailing Address - Phone:813-563-6526
Mailing Address - Fax:813-948-0094
Practice Address - Street 1:20747 STERLINGTON DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-4317
Practice Address - Country:US
Practice Address - Phone:813-563-6526
Practice Address - Fax:813-948-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty