Provider Demographics
NPI:1326278144
Name:PAMELLA MONTGOMERY PH D PLLC
Entity Type:Organization
Organization Name:PAMELLA MONTGOMERY PH D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-347-7736
Mailing Address - Street 1:4123 OKEMOS RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2818
Mailing Address - Country:US
Mailing Address - Phone:517-347-7736
Mailing Address - Fax:517-347-4644
Practice Address - Street 1:4123 OKEMOS RD
Practice Address - Street 2:SUITE 14
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2818
Practice Address - Country:US
Practice Address - Phone:517-347-7736
Practice Address - Fax:517-347-4644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010005451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty