Provider Demographics
NPI:1447879291
Name:CHANCE, MONTIQUE (LPC)
Entity type:Individual
Prefix:
First Name:MONTIQUE
Middle Name:
Last Name:CHANCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 SAM BASS RD # 962
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4214
Mailing Address - Country:US
Mailing Address - Phone:512-626-3305
Mailing Address - Fax:
Practice Address - Street 1:797 SAM BASS RD # 962
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4214
Practice Address - Country:US
Practice Address - Phone:417-708-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional