Provider Demographics
NPI:1144888173
Name:MONTOYA, MARTIN (LPC)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SLAWIN CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2183
Mailing Address - Country:US
Mailing Address - Phone:847-789-7155
Mailing Address - Fax:
Practice Address - Street 1:625 SLAWIN CT
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2183
Practice Address - Country:US
Practice Address - Phone:847-789-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional