1588183214 NPI number — MONICA L. MONTGOMERY, LCSW, LLC

Table of content: (NPI 1588183214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588183214 NPI number — MONICA L. MONTGOMERY, LCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONICA L. MONTGOMERY, LCSW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588183214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 MIDPOINT DR STE 301B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80525-4342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-218-9341
Provider Business Mailing Address Fax Number:
970-797-1258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14241 E 4TH AVE STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80011-8758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-218-9341
Provider Business Practice Location Address Fax Number:
970-788-7418
Provider Enumeration Date:
09/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MONTGOMERY
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
970-218-9341

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW.09924178 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com