Provider Demographics
NPI:1669955647
Name:MONTANO, ESTEBAN (AMFT)
Entity type:Individual
Prefix:MR
First Name:ESTEBAN
Middle Name:
Last Name:MONTANO
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17317 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:ESPARTO
Mailing Address - State:CA
Mailing Address - Zip Code:95627-2137
Mailing Address - Country:US
Mailing Address - Phone:530-787-4110
Mailing Address - Fax:530-787-4104
Practice Address - Street 1:200 BAKER STREET ROOM 4 & 5
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694
Practice Address - Country:US
Practice Address - Phone:530-794-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106607106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist