Provider Demographics
NPI:1669191516
Name:MONTOYA, JOLEEN AMY (LMSW)
Entity type:Individual
Prefix:
First Name:JOLEEN
Middle Name:AMY
Last Name:MONTOYA
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SANTISTEVAN LN
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6068
Mailing Address - Country:US
Mailing Address - Phone:575-613-0485
Mailing Address - Fax:
Practice Address - Street 1:1337 GUSDORF RD STE O
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6298
Practice Address - Country:US
Practice Address - Phone:575-224-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-08491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical