Basic Information
| Provider Information | |||||||||
| NPI: | 1366751224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTES | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6931 VAN NUYS BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183760134 | ||||||||
| FaxNumber: | 5628655244 | ||||||||
| Practice Location | |||||||||
| Address1: | 6931 VAN NUYS BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183760134 | ||||||||
| FaxNumber: | 5628655244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 94600 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.