Provider Demographics
NPI:1053138040
Name:MONTGOMERY, LUKE L
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:L
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 ASPEN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-1663
Mailing Address - Country:US
Mailing Address - Phone:507-381-5568
Mailing Address - Fax:
Practice Address - Street 1:209 S 2ND ST STE 306
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3639
Practice Address - Country:US
Practice Address - Phone:507-387-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health