Basic Information
| Provider Information | |||||||||
| NPI: | 1104338284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NICOLE MONTA PSYCHOTHERAPY, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1322 ARBOR CREEK DR | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483063700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176142925 | ||||||||
| FaxNumber: | 2482941106 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483071817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176142925 | ||||||||
| FaxNumber: | 2482941106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2017 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | MONTA | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 5176142925 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.