Provider Demographics
NPI:1346897634
Name:MONTGOMERY,, ERIN JEANETTE (LMFT, LSAA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JEANETTE
Last Name:MONTGOMERY,
Suffix:
Gender:F
Credentials:LMFT, LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MESCALERO RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6542
Mailing Address - Country:US
Mailing Address - Phone:575-755-2272
Mailing Address - Fax:575-622-3325
Practice Address - Street 1:110 E MESCALERO RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6542
Practice Address - Country:US
Practice Address - Phone:575-755-2272
Practice Address - Fax:575-622-3325
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAMF0213311106H00000X
NMCTB-2022-0112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73728306Medicaid