Provider Demographics
NPI:1679310577
Name:MONTGOMERY, EMMY
Entity type:Individual
Prefix:
First Name:EMMY
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E WACKERLY ST STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7043
Mailing Address - Country:US
Mailing Address - Phone:989-444-3209
Mailing Address - Fax:
Practice Address - Street 1:111 E WACKERLY ST STE A
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-7043
Practice Address - Country:US
Practice Address - Phone:989-444-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional