Provider Demographics
NPI:1912110453
Name:UKEP MONTWOOD CAMPUS LLC
Entity type:Organization
Organization Name:UKEP MONTWOOD CAMPUS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-591-2101
Mailing Address - Street 1:11150 MONTWOOD DRIVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4240
Mailing Address - Country:US
Mailing Address - Phone:915-591-2101
Mailing Address - Fax:915-591-2116
Practice Address - Street 1:11150 MONTWOOD DRIVE
Practice Address - Street 2:BUILDING A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4240
Practice Address - Country:US
Practice Address - Phone:915-591-2101
Practice Address - Fax:915-591-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12497235Z00000X
TX9101101YA0400X
TX19422101YP2500X
TXCERTIFICATION101YS0200X
TX08025063235Z00000X
TX18407101YP2500X
TXM 51812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty