Provider Demographics
NPI:1427324102
Name:MONTELONGO, DOROTHY (LPC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:MONTELONGO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:V
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5025 MAYLANDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3620
Mailing Address - Country:US
Mailing Address - Phone:361-688-7366
Mailing Address - Fax:
Practice Address - Street 1:5025 MAYLANDS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413
Practice Address - Country:US
Practice Address - Phone:361-688-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296086602Medicaid