| Doctor Name: | EMMANUEL MONTENEGRO |
| NPI Number: | 1124412150 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | CO60543845 |
| Business Practice Address: | 31640 State Route 20 Suite 1 Oak Harbor, WA - 982773128 |
| Business Phone Number: | 3606797676 |
| Business Fax Number: | |
| Mailing Address: | Po Box 34703, SEATTLE |
| State: | WA |
| Postal Code: | 981241703 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2015 |
| NPI Last Update Date: | 03/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CO60543845 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |