Provider Demographics
NPI:1073613774
Name:MONTGOMERY, F. MICHAEL (LCSW, MFT)
Entity Type:Individual
Prefix:MR
First Name:F.
Middle Name:MICHAEL
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3907
Mailing Address - Country:US
Mailing Address - Phone:707-578-9385
Mailing Address - Fax:707-578-9271
Practice Address - Street 1:1209 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3907
Practice Address - Country:US
Practice Address - Phone:707-578-9385
Practice Address - Fax:707-578-9271
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS61841041C0700X
CAMFT15488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist