Provider Demographics
NPI:1447792965
Name:EDGAR MONTES
Entity type:Organization
Organization Name:EDGAR MONTES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:505-220-0975
Mailing Address - Street 1:1108 MADISON ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1108 MADISON ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4414
Practice Address - Country:US
Practice Address - Phone:505-220-0975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0069951251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health