Provider Demographics
NPI:1134635964
Name:KEIG, MONTANA (MS APC)
Entity Type:Individual
Prefix:
First Name:MONTANA
Middle Name:
Last Name:KEIG
Suffix:
Gender:F
Credentials:MS APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CAMDEN HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-2448
Mailing Address - Country:US
Mailing Address - Phone:770-513-8988
Mailing Address - Fax:770-513-2565
Practice Address - Street 1:1750 SHILOH RD NW APT 713
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6466
Practice Address - Country:US
Practice Address - Phone:404-444-3146
Practice Address - Fax:770-513-2565
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
GAAPC007354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor