Provider Demographics
NPI:1700918901
Name:MONTOYA, BARBRA RACHELLE
Entity Type:Individual
Prefix:
First Name:BARBRA
Middle Name:RACHELLE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBRA
Other - Middle Name:RACHELLE
Other - Last Name:GOODNOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:729 REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3332
Mailing Address - Country:US
Mailing Address - Phone:970-484-7447
Mailing Address - Fax:970-482-8713
Practice Address - Street 1:729 REMINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3332
Practice Address - Country:US
Practice Address - Phone:970-484-7447
Practice Address - Fax:970-482-8713
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94773301Medicaid