Individual
CHARLENE MONTOYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LED, ASDCS
Contact information
Practice address
1762 MAIN STREET, SAN ANTONIO, NM 87832
(575) 418-0675
Mailing address
PO BOX 463, SAN ANTONIO, NM 87832-0463
(575) 418-0675
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
285442
NM
251S00000X
Community/Behavioral Health Agency
285442
NM
Other
Enumeration date
04/15/2022
Last updated
02/16/2023
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