Monty Keith Dale
Individual provider Active NPI Professional Counselor · Blythe, CA
NPI 1104595685 · NPPES record last updated Sep 8, 2021
Key facts
- NPI
- 1104595685
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 8833 (CA)
- Practice address
- 2200 E Donlon St Apt 2476C
Blythe, CA 92225-3044 - Phone
- (310) 279-0756
- NPI assigned
- Sep 8, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 8833 | CA | Yes |
Addresses
Primary practice location
2200 E Donlon St Apt 2476C
Blythe, CA 92225-3044
Mailing address
2200 E Donlon St Apt 2476C
Blythe, CA 92225-3044
Phone (310) 279-0756
Other providers in Blythe, CA
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- Carl Dahlstrom
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- Theresa Rodriguez Davila
- Ashley Christine Defreese
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All providers in Blythe, CA · Professional Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.