Provider Demographics
NPI:1003067125
Name:MONTGOMERY, LAUREN M (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 RAILROAD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4121
Mailing Address - Country:US
Mailing Address - Phone:425-582-2160
Mailing Address - Fax:425-582-2160
Practice Address - Street 1:144 RAILROAD AVE STE 202
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4121
Practice Address - Country:US
Practice Address - Phone:425-582-2160
Practice Address - Fax:425-582-2160
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist