Provider Demographics
NPI:1477689768
Name:MONTGOMERY, ELAINE RUTH (COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:RUTH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:RUTH
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:220 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5140
Mailing Address - Country:US
Mailing Address - Phone:337-948-0226
Mailing Address - Fax:337-948-0399
Practice Address - Street 1:220 S MARKET ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5140
Practice Address - Country:US
Practice Address - Phone:337-948-0226
Practice Address - Fax:337-948-0399
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN077372101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor