Provider Demographics
NPI:1053971671
Name:MONTGOMERY, LAURA ELIZABETH (MED, BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 BEE CAVES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7180
Mailing Address - Country:US
Mailing Address - Phone:512-524-1374
Mailing Address - Fax:512-524-1355
Practice Address - Street 1:3423 BEE CAVES RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-7180
Practice Address - Country:US
Practice Address - Phone:512-524-1374
Practice Address - Fax:512-524-1355
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-19-36649OtherBACB