Provider Demographics
NPI:1316245806
Name:MONTOYA, LEAH THERESA
Entity type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:THERESA
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8917
Mailing Address - Country:US
Mailing Address - Phone:505-917-1762
Mailing Address - Fax:
Practice Address - Street 1:409 ASHLEY LN
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8917
Practice Address - Country:US
Practice Address - Phone:505-917-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-17-25540103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst