Provider Demographics
NPI:1053921072
Name:LA MONTE, C ALYSE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:C
Middle Name:ALYSE
Last Name:LA MONTE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CHERYL ANN
Other - Middle Name:ALYSE
Other - Last Name:LANGBECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:528 COTTAGE ST NE STE 340
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3788
Mailing Address - Country:US
Mailing Address - Phone:503-584-1941
Mailing Address - Fax:503-689-1812
Practice Address - Street 1:528 COTTAGE ST NE STE 340
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3788
Practice Address - Country:US
Practice Address - Phone:503-584-1941
Practice Address - Fax:503-689-1812
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201392887RN163W00000X
OR202100427NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse