Provider Demographics
NPI:1780017475
Name:MONTANO, MELODY (LP, PHD)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MONTANO
Suffix:
Gender:F
Credentials:LP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17503 LA CANTERA PKWY STE 104-627
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-8207
Mailing Address - Country:US
Mailing Address - Phone:210-614-4990
Mailing Address - Fax:210-614-4991
Practice Address - Street 1:5522 LONE STAR PKWY STE 330
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6719
Practice Address - Country:US
Practice Address - Phone:210-614-4990
Practice Address - Fax:210-614-4991
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69910101YM0800X, 101YP2500X
TX40236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional