Provider Demographics
NPI:1114553690
Name:MONTAGUE, SHARRON (LMSW)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 CASS RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9153
Mailing Address - Country:US
Mailing Address - Phone:231-499-3057
Mailing Address - Fax:231-368-6270
Practice Address - Street 1:3639 CASS RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9153
Practice Address - Country:US
Practice Address - Phone:231-227-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011032971041C0700X
MI68011124241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical