Provider Demographics
NPI:1346794146
Name:MONTOYA, ALICIA (MA, LLP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 EATON RAPIDS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6307
Mailing Address - Country:US
Mailing Address - Phone:517-618-9533
Mailing Address - Fax:
Practice Address - Street 1:608 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-1321
Practice Address - Country:US
Practice Address - Phone:517-256-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37464103TC1900X
MI6361000711103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling