Provider Demographics
NPI:1114111952
Name:MONTGOMERY, SHAUNTEEKA KLARISSA
Entity Type:Individual
Prefix:MS
First Name:SHAUNTEEKA
Middle Name:KLARISSA
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 1:1507 21ST ST
Mailing Address - Street 2:3131 PALMER STREET
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5220
Mailing Address - Country:US
Mailing Address - Phone:916-921-6099
Mailing Address - Fax:916-649-1130
Practice Address - Street 1:3131 PALMER ST # 13
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-1412
Practice Address - Country:US
Practice Address - Phone:916-921-6099
Practice Address - Fax:916-649-1130
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health