Provider Demographics
NPI:1538875315
Name:MONTENEGRO, JOHANNA (MA, LPC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 OLD SAN ANTONIO RD STE 503
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3492
Mailing Address - Country:US
Mailing Address - Phone:210-771-1560
Mailing Address - Fax:
Practice Address - Street 1:138 OLD SAN ANTONIO RD STE 503
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3492
Practice Address - Country:US
Practice Address - Phone:210-771-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0OtherN/A