Provider Demographics
NPI:1831541317
Name:MONTALVO, GLENDA MARISOL (MD, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:MARISOL
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:MD, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12114 ARROWHEAD GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2404
Mailing Address - Country:US
Mailing Address - Phone:281-221-8999
Mailing Address - Fax:
Practice Address - Street 1:24124 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8396
Practice Address - Country:US
Practice Address - Phone:855-782-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-22310103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst