Provider Demographics
NPI:1235861162
Name:MONTGOMERY, TEELEE
Entity Type:Individual
Prefix:
First Name:TEELEE
Middle Name:
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 1:9350 DOUBLE R BLVD APT 3916
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-3844
Mailing Address - Country:US
Mailing Address - Phone:858-736-1540
Mailing Address - Fax:
Practice Address - Street 1:415 HWY 95A, BLDG. G
Practice Address - Street 2:SUIT 701
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408
Practice Address - Country:US
Practice Address - Phone:775-575-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist